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WAR CORRESPONDENCE 

( HISPANO-AMERICAN WAR ) 



LETTERS FROM 



DR. NICHOLAS SENN 

CHIEF SURGEOX U.S. VOLUNTEERS. 
CHIEF OF OPERATING STAFF WITH THE ARMY IN THE FIELD. 



REPRINTED FROM THE 
JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. 



CHICAGO: 
American Medical Association Press. 

1899. 






2^ ^1 ^^ ^> - B 



CONTENTS. 



War Correspondence 1 

An Old Battle Ground 24 

Letter from Camp George H. Thomas 31 

Assigned to a New Field 41 

The Floating Hospitals 50 

The Medical Department of the Army in the Cuban Cam- 
paign 55 

The Qualifications and Duties of the Military Surgeon . . 61 
The Invasion of Porto Rico from a Medical Standpoint . . 79 

Typhoid Fever in the Porto Rican Campaign 95 

The Returning Army 101 

The National Cry 108 

Our Relief Societies 115 

The Wounded of the Porto Rican Campaign 122 

On the Frequency of Cryptorchism and its Results .... 131 

The Seat of War and our Military Surgeons 133 

Headquarters Fifth Army Corps 138 

Recent Experiences in Military Surgery after the Battle of 

Santiago 146 

The Surgpr;, ot Camp Wikoff 183 

Empyema in Camp George H. Thomas 237 

Esculapius on the Field of Battle 255 

Nurses and Nursing in War 265 



WAR CORRESPONDENCE. 



The beating of the drum, the measured tread of an armed 
host are again heard throughout the land and have aroused 
the patriotic spirit of the American people. For a fifth time 
our nation is face to face with a war the gravity of which it is 
impossible to estimate at the present time. The first war 
brought us our liberty and independence ; the second estab- 
lished our reputation on the sea ; the third taught our Mexican 
neighbor respect for our country ; the fourth saved the Union, 
and the fifth, which is now being waged, was provoked in the 
cause of humanity. 

For centuries the beautiful neighboring island of Cuba has 
been in the greedy grasp of a foreign nation. The people to 
whom this gem of the ocean belongs have been downtrodden, 
tyrannized over and abused by the cold iron hand of an effete 
monarchy. The humane liberty-loving people of the United 
States have heard the cry of the oppressed starving Cubans 
for years, and have done all in their power, short of resort to 
the sword,' to relieve their sufferings, but without avail. The 
ear of the proud, cowardly Spainard remained deaf to well- 
meant and most earnest appeals. The Chief Executive of the 
United States exhausted every resource to improve the condi- 
tion of the native Cubans, the rightful owners of the unfor- 
tunate island, without bloodshed, but all his efforts were 
ignored and antagonized by the brutal oppressors. 

War is always a great calamity, but when entered upon for 
the sake of humanity, for the relief of the oppressed, it becomes 
a weapon in the hand of the Almighty. The issue before us is 
a righteous one, and it is not difficult to forecast the ultimate 
result. Justice and humanity are on our side ; corruption and 
oppression on the other. On our part the struggle is purely 
unselfish ; on the other it is a desperate but vain attempt to 
ignore the claims of an enslaved people. Such are the condi- 
tions of the present war with Spain, at the same time our peo- 
ple will now and for all time come *' Remember the Maine." 



The war has begun, the deafening roar of cannon has been 
heard in different Spanish ports, the hero of Manila has planted 
the Stars and Stripes, the emblem of liberty and equality, on 
the shores of the distant Philippine Islands ; there it will 
remain until the unhappy inhabitants breathe the bracing air 
of independence. No war was ever undertaken in which the 
government had such a firm and enthusiastic support from the 
mass of the people regardless of politics, religion, nationality 
and position in life. 

The policy laid out, advised and carried in effect by President 
McKinley, meets with the undivided support of the reunited 
nation. The gray is eager and anxious to don the blue in his 
country's cause. Federal and Confederate meet again to talk 
over the memories of the past at a common camp fire during 
the campaign against a common foe, who has been permitted 
far too long a time to abstract the life blood of an innocent 
people, the legitimate owners of one of God's most beautiful 
islands so close to our own great, forever free and united 
country. 

ILLINOIS ARMY. 

Illinois has always been in the front when our country was 
in danger. Its record during the War of the Rebellion stands 
foremost in the history of the nation. It gave to the nation 
Abraham Lincoln, who, during the dark days of the Rebellion, 
guided the Ship of State through many a storm and many a 
danger into a harbor of safety and gave freedom to a despised 
and degraded race. It gave to the nation Grant, who led the 
army from victory to victory, until the misguided but deter- 
mined foe was willing to sue for peace and accept the terms 
offered by its conqueror. It gave the nation a Logan, whose 
heroic and gallant deeds brought terror to the enemy. It gave 
the nation an army of soldiers who took an honorable and heroic 
part in the deadly conflict. It gave the nation Dick Oglesby, the 
intimate friend of Lincoln, who happened to be in Washington 
on the memorable night of Lincoln's assassination. The moment 
the fatal shot was fired he was summoned, and when he arrived 
at the entrance of the house to which Lincoln had been taken, 
he was confronted by an armed guard who refused him admis- 
sion. There was no time for argument ; the sturdy Governor 
grasped the guard by his collar and pushed him aside like a 




J. N, Reece, Adjutant-General. 



toy, with the words, '' I am the Governor of Illinois, get out of 
my way!" 

Illinois will do her share in the present conflict. When the 
War Department called for troops, the message was received 
by Governor Tanner on April 26. After a brief consultation 
with Adjutant-General Reece, the button was touched flashing 
the order over the wires to the regimental commanders in 
different parts of the State, and in less than thirty six hours 
10,000 men were at the State Fair Grounds at Springfield ready 
to do their duty. General Barkley, the senior Brigadier Gen- 
eral, was placed in command of the post, which he named 
Camp Tanner, and thanks to his foresight, energy and knowl- 
edge of military art, the troops received proper shelter and 
were assigned to their quarters immediately upon their arrival. 
Adjutant-General Reece demonstrated by every act that he 
was master of the situation. There was probably never a time 
when upon such short notice a temporary camp for so large a 
force was made more comfortable and efficient. Both of these 
officers, as well as their subordinates, are entitled to great 
credit and to the thanks of the good people of Illinois for 
having acted so promptly and wisely to efficiently meet such an 
emergency. The newspaper reporters and visitors to the camp 
were astonished by the fact that no complaints were made 
either by officers or men. Considering the limitations of equip- 
ment, the number of men in the camp, the unprecedentedly 
disagreeable weather and the short notice, this must certainly 
appear as the most satisfactory proof of the intense patriotism 
which animated every man and made him ignore his physical 
requirements in the thought that he was called upon to dis- 
charge a duty to his country. 

A few days after the arrival of the seven regiments of infati- 
try and the First Regiment of Cavalry, Captain Yeager of Bat- 
tery A, First Artillery, appeared in camp with a splendid body 
of well drilled mec, which added much to the military appear- 
ance of the camp. The representatives of the United States 
army, Lieutenant-Colonel Roberts, Captain Swift and Lieuten- 
ants Ballou, Cole and Davis were on the field early and ren- 
dered invaluable service in the organization and mustering in 
of the troops. It was indeed pleasant to observe the harmony 
in word and action which prevailed between these officers of the 



regular army and the officers and men of the National Guard. 
This war will do much in cementing together more closely the 
professional and citizen soldier. In less than four weeks all 
of the troops were examined, mustered into the United States 
service and turned over to the Government. 




Lieutenaut-Colonel Roberts. 

The Fifth and Third Regiments of Infantry were the first to 
leave Camp Tanner amid the cheers of their comrades left 
behind. In due time they reached their appointed station. 
Camp George H. Thomas, Chickamauga, Ga. The Sixth 
Infantry was next ordered to Camp Alger, Falls Church, Va., 



6 



near Washington, and the First Infantry a few days later 
joined their comrades of the Third and Fifth Regiments at 
Chickamauga. The Second Infantry was then ordered to 
Tampa, but en route received notice to report at Jacksonville, 
Fla. The Fourth Infantry, after considerable delay, was 
ordered to Tampa, the Seventh Infantry to Virginia, and the 
First Cavalry is now on its way to Camp Thomas, Chickamauga. 

GOVERNOR TANNER. 

The oflBce of governor of a State is always important and 
responsible, but especially so in time of war. The citizens of 
Illinois have reason to congratulate themselves that during 
the last election their choice fell upon the right man at the 
right time. Governor Tanner has shown that he is made of 
the right metal for an effective and wise war governor. His 
experience during the late war as a private has been of great 
value to him in meeting the duties of the hour. He knows 
what it is to serve in the ranks, and has therefore taken the 
•deepest interest in the welfare and comfort of every soldier who 
has come to the camp. He is a staunch friend of the common 
people (the backbone of the nation), and has catered but little 
if any, to the whims and fancies of the silk stocking element. 
He is now more popular than ever with the National Guard. 
He takes pride in his army. He imbues every soldier with the 
idea that the highest position is within his reach if he devotes 
himself to his legitimate duties. He has strained every nerve 
in bringing his troops to the front, and has had the satisfac- 
tion of seeing an Illinois regiment the first to be mustered into 
the volunteer service of the United States, and that the State 
he represents has thus taken the lead as regards prompti- 
tude and dispatch in answering the call of the President for 
volunteers. 

Our Governor is intensely patriotic ; he has shown this in 
every act in the organization and equipment of the troops. It 
is not generally known that Governor Tanner is a great orator ; 
the speech which he made at a banquet he gave to the officers 
of his staff and of the regiments in camp, was a revelation to 
every one present. He seemed to be inspired ; his eyes flashed : 
©very nerve and muscle responded to his intense emotion ; 
every word and thought found a hearty response in the hearts 
of his profoundly interested audience. I doubt very much if 



he will ever be able to duplicate that speech, because such an 
occasion comes but once during a man's life. It was a speech 
which left a deep and permanent impression, a speech calcula- 
ted to make a man better and more devoted to his country and 
his country's flag. 




JoHn R. Tanner, Governor of Illinois. 



The Governor has visited the camp daily and always has a 
cheerful word and a pleasing smile for every one he meets, pri- 
vates and officers alike. John R. Tanner will go down in his- 
tory as a famous war governor, a worthy successor to Govern- 
ors Yates and Oglesby. 

MRS. TANNER. 

The beautiful, youthful and accomplished wife of our Gov- 
ernor came to the Executive Mansion at the right time. She 
takes great interest in the work of her distinguished husband. 




Mrs. John R. Tanner, 

She is a great favorite with the people of Springfield. She is 
ready in conversation and quick in perception. She visits the 
camp frequently and takes an active interest in the care of the 
sick. Her cheerful disposition and her tender care of her hus- 
band have done much to lighten the heavy burden and many 
perplexities, which have been resting upon the shoulders of 
our overtaxed Governor since he assumed the duiies of his 
office, and more particularly since the declaration of war with 
Spain. 



9 



THE CAMP GROUND. 

When the sudden call for troops came it was an important 
matter to select a camp centrally located and adapted for the 
season of the year. The oflBcers of the State Agricultural 
Society came to the rescue of the military authorities and 




Brigadier-General James H. Barkley, Senior Commander of the Camp. 



10 



offered gratuitously the State Fair Grounds forthe use of the 
troops during mobilization. The grounds occupy 160 acres of 
land, north of the city limits, and are easily accessible by a line 
of electric cars. The surface of the ground is undulating and 
divided by several ravines well adapted for effective surface 
drainage with a little expenditure of time and money. The 
subsoil is of clay, which in combination with the continued 
rains made the streets pools of mud for more than a week, a 
destroyer of foot gear and a rich harvest for the bootblack. 

The permanent buildings were well adapted for temporary 
quarters for the imperfectly equipped soldier. For two weeks 
two of the regiments lived in tents. The camp was supplied 
with filtered water from the Sangamon River, A specimen of 
the water was sent for analysis to Dr. A. W. Palmer, professor 
of chemistry at the State University, who pronounced it whole- 
some and practically pure. 

A sufficient number of sinks were dug and boarded in and 
the dejecta were daily covered with dry earth. Fresh straw 
was furnished in abundance. The rations were satisfactory 
both in quantity and quality, 

EXAMINATION OF SURGEONS FOR THE UNITED STATES VOLUN- 
TEER SERVICE. 

Soon after the troops reached Camp Tanner an order was 
sent from the War Department to Governor Tanner, making 
provision for the formation of an Examining Board. This 
board was to consist of one surgeon from the United States 
Army and two National Guard surgeons. The Government 
detailed Capt. H. P. Birmingham, U. S. A., stationed at 
Chicago, and Governor Tanner appointed Surgeon General 
Senn and Brigade Surgeon C. C. Carter of Rock Island, as 
members of the board. The duties of this board were to con- 
sist in the examination both as to physical condition and pro- 
fessional attainments of applicants for commissions in the 
Medical Department of the United States volunteers and the 
National Guard volunteer forces. The board was organized at 
once and proceeded to examine applicants for the Medical 
Department. The following blank was drawn up, typewritten, 
and presented to each applicant to fill out : 

Applicants for the volunteer service are respectfully requested 
to fill out carefully the following blanks : 



11 



1. Name . 2. Age . 3. Height . 4. Weight . 

5. Family history . 6. Physical defects, if any, either of 

congenital or acquired sources . 7. Residence and P. O. 

address . 8. Command, if any . 9. Place and date 

of graduation , 10. Professional or scientific study and 

investigation, other than military . 11. Foreign languages 

studied ; a, able to speak ; b, able to translate . 



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Surgeons of the Natiooal Guard and Illinois Volunteers. 

12. Subjects or titles of books written or published, essays 
prepared, lectures delivered or papers read, when and where 

; a, No. ; 6, ; c, . Remarks . 

The physical examination was made in a very thorough man- 
ner, the man being stripped, and demonstrated that the candi- 
dates for commissions in the Medical Department compared 
favorably with the line and field ofl&cers. Out of the whole 
number only three were rejected. 



12 



It was the intention of the Board, in view of th^ fact that 
most of the candidates had done good service in the National 
Guard for a longer or shorter period, to make the examination 
as broad and practical as possible. The following are some of 
the subjects on which the examination was conducted : 

Anatomy and Surgery,—!. Give the origin and distribution 
of the pneumogastric nerve. 2. Mention the bones of the car- 
pus and give their relative locations by illustration. 3. Describe 
the innominate artery and give its relations to surrounding 
structures. 4. Enumerate the different hemostatic measures 
and describe their technic and indications. 5. Detail the treat- 
ment of recent compound fracture of the leg, 6. Describe the 
different amputations through and below the ankle joint and 
mention the names of the surgeons who devised them. 

Hygiene. — 1. Give your ideas on the selection and sanitation 
of camps. 2. The prophylaxis and treatment of sunstroke. 
3. How would you determine, in the field, in a general way, 
the salubrity of the water-supply, and what measures would 
you take for preventing its pollution? 

Military surgery. — 1. Give method of treating (temporary) 
gunshot fracture of the thigh, on the field, and when and how 
would you remove the patient? 2. What is the effect produced 
by modern small jacketed bullet, compared with the old large 
caliber missile? 3. Give method of procedure in rendering 
first aid to, and removal of, wounded from fighting line to field 
hospital. 

Practice of medicine. — 1. Describe pneumonia : Definition, 
etiology, morbid anatomy, symptoms, complications, prognosis, 
termination, diagnosis, treatment. 2. Describe cerebrospinal 
meningitis : Cause, pathology, symptoms, diagnosis, prognosis, 
treatment. 3. Describe diseases most liable to occur in trop- 
ical countries, with short description of causes, symptoms, 
pathology, prophylaxis, diagnosis and treatment. 

Materia medica. — 1. What are the more common forms of 
mercury used in medicine? Write prescriptions for four. 2. 
Mention the comparative advantages of ether and chloroform 
as anesthetics. 3. Indications for the use of emetics, cathar- 
tics and alcohol. 

The minimum standard was fixed at 70. It was a source of 
great gratification to the Board that, notwithstanding the fact 



13 



that many of the applicants had been busy practitioners for 
years, the papers they turned in were of a high character. The 
result of the examination shows that in these applicants the 
State had desirable material for service in the volunteer regi- 
ments. 

The fact that the revised code of the Illinois National Guard 
made provision for five surgeons to each regiment and the 
regulation for the United States Volunteer Service called for 




Group of Hospital Stewards Illinois Volunteers. 

only three, made it necessary for the junior assistant surgeons 
of some of the regiments to return unwillingly to their respec- 
tive homes. 

As soon as the results of the examination were announced, 
the assignments were made. The following is a list of the 
medical ofl&cers of the volunteer forces of Illinois : 

First Infantry. Surgeon, W. G. Willard ; Assistant Sur- 
geons, T. E. Roberts and C. B. Walls. 



14 

Second Infantry. Surgeon, G. F. Lydeton ; Assistant Sur- 
gedns, J. G. Byrne and G. P. Marquis. 

Third Infantry. Surgeon, J. B. Shaw ; Assistant Surgeons, 
A. F. Lemke and C. E. Starrett. 

Fourth Infantry. Surgeon, T. C. McCord ; Assistant Sur- 
geons, C, M. Galbraith and G. E. Hilgard. 

Fifth Infantry. Surgeon, M. R. Keeley ; Assistant Surgeons, 
E. A. Ames and J. L. Bevans. 

Sixth Infantry. Surgeon, F. Anthony ; Assistant Surgeons, 
C. A. Robbins and L. S. Cole. 

Seventh Infantry. Surgeon, T. J. Sullivan ; Assistant Sur- 
geons, G. W. Mahoney and F. P. St. Clair. 

First Cavalry. Surgeon, W. Cuthbertson; Assistant Sur- 
geons, T. J. Robeson and J. Rowe. 

Battery A, First Artillery. Hospital Steward, Dr. Jackson. 

PHYSICAL EXAMINATION OF FIELD AND LINE OFFICERS 
AND ENLISTED MEN. 

The examinations were conducted at the Senate Chamber of 
the State House from 9 a.m. to 6 p.m. daily, with an interval of 
an hour for lunch. The Board of Examiners was assisted by 
the regimental surgeon of each regiment and his assistants. 
The officers were examined separately in the Lieutenant Gov- 
ernor's room. One of the assistant surgeons took the chest 
expansion, another examined the eyes and ears and a third the 
head, mouth, pharynx and neck. The Surgeon-General exam- 
ined the lower extremities and abdomen, and Captain Birming- 
ham the chest and the general aptitude for active service. 
Colonel Carter acted as clerk in conjunction with a number of 
the field and line officers. 

The following blanks for physical examination were drawn 
up, and 10,000 copies were printed and distributed to the vari- 
ous regiments : 

PHYSICAL EXAMINATION. 

Name . Rank . Co. . Regiment . Age . 

Residence . Chest Expansion . Inspiration . 

Expiration . Are you subject to coughs or colds? . 

Have you ever had any serious illness? . Are you subject 

to sore throat? . Discharge of the ear? . Rheuma- 
tism? . Stiffening of the joints? . Hemorrhoids or 

piles? . Fistula? . Diarrhea or dysentery? . Do 

you believe you are sound and well now? . 



15 



Soon after the arrival of the Surgeon-General an order \^as 
issued instructing the regimental medical officers to make a 
preliminary physical examination of the recruits, which resul- 
ted in the return to their homes of several hundred men phys- 




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ically unfit for duty and which materially assisted the work of 
final examination. The most unenviable part of the examina- 
tion fell upon the shoulders of the Surgeon-General, who for 
the purpose of quickening and lightening his duties devised 



the followiog commands : Heels together ! Turn around ! 
Turn back ! Cough ! Cough harder ! which commands after- 
ward became a favorite and familiar chorus among the men 
who passed the final ordeal to the satisfaction of the Board. 
On an average, it was found possible by following the thorough 
system adopted, to examine from 800 to 950 recruits a day. In 
all, 9899 men were examined. 

The most common causes for rejection were hernia, varicose 
veins of the lower extremities, poor physique, heart disease, 
imperfect chest expansion, loss of teeth and flat foot. The 
presence of varicocele of different degrees in men otherwise 
apparenly in good health was marked. It was found that 
nearly 25 per cent, of all those examined presented a condition 
of varicocele of some degree. Only two recruits were rejected 
for this cause, as in their cases the varicocele appeared to be 
an acknowledged source of pain. In all the rest the statement 
was plainly made either that the applicant had no knowledge 
of the condition, or that it gave rise to no inconvenience. In 
probably one-half of all the cases the subjects were ignorant 
of the existence of this condition. The same remark may 
apply to flat foot as a cause of rejection, inasmuch as the 
deformity appeared to be extremely common, but only in a 
few isolated cases was it a cause of pain and consequently of 
disability for the volunteer service. The rejections for good 
and substantial causes were less than 10 per cent. This was 
influenced somewhat by the thoroughness with which the pre- 
liminary examinations had been conducted. The proportion of 
rejections was, on the whole, larger in the country regiments 
than in those made up of Chicago men. A great many men 
who passed the physical examination returned unwillingly to 
their homes by reason of the regulation reducing the number 
of men to a company from 109 to 84. 

The intensity of the patriotic feeling which pervaded the 
men in camp is best shown by the illustrations which accom- 
pany this communication. The word "rejected" in many • 
instances seemed to make a more profound impression than 
would a death sentence. The disappointment would be such 
that the soldier was often speechless, pale, staggering, and in 
not a few instances hot tears would roll down the bronzed 
cheeks as the best evidence of the deep regret of the recruit 



17 




Illinois Volunteer mustered in and fully equipped. 



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in being deprived of the great privilege of defending the honor 
of his country. On the other hand, the successful soldier 
would accept active service with a smiling countenance and 
would bound away into the dressing-room like a deer pursued 
by hounds. 

SCHOOL OF INSTRUCTION FOR MEDICAL OFFICERS. 

The second day after the Surgeon-General arrived at the 
Camp, he sent a telegram to Professor A. D. Bevan of Rush 
Medical College, Chicago, requesting him to send by the earl- 
iest train a cadaver for anatomic demonstration, and a course 
of operative surgery. The cadaver arrived promptly and a 
small amphitheater was extemporized in the Assembly Hall, 
which served as headquarters for the Third and Sixth Infan- 
try. The hours between 8 and 10 p.m. were utilized in giving 
lectures, anatomic demonstrations, and a course in operative 
surgery. In this course not only the medical officers, but the 
members of the hospital corps took an active interest. The 
Surgeon-General domonstrated on the cadaver emergency 
operations with especial reference to military surgery ; one of 
the assistant surgeons made a dissection every day, and in the 
evening demonstrated his work to the class. Among the 
demonstrations made were the following : 

Major Lydston, operations on the urethra and bladder. 
Major Cuthbertson, hernia operations. Major Adams, osteo- 
plastic resection of the skull. Colonel Kreider gave a lecture 
at St. John's Hospital, Springfield, on Sterilization in Surgery, 
demonstrating his remarks by the exhibition of the means em- 
ployed in the hospital for this purpose. Among the lecturers 
were the following: Colonel C. C. Carter, "Prescribing in 
Military Practice." Major Adams, "Shock and Sunstroke, 
and Temporary Hemostasis." Major Sullivan, "Temporary 
Dressing of Fractures." Major McCord, "Prevention and 
Treatment of Camp Diarrhea." Captain Mahoney, "Preven- 
tion and Treatment of Gonorrheal Ophthalmia." Lieutenant 
Hilgard, "Treatment of Dysentery." Lieutenant Stanton, 
"Administration of Anesthetics." This School of Instruc- 
tion was continued for nearly four weeks, and was found 
to be interesting, useful and well calculated to prepare 
the medical officers for their future work in the field. Those 
who took an active part in the teaching had the moral support 



19 




20 



of both field and line officers, who did everything in their power 
to encourage them in their work. 

LECTURES ON FIRST AID, 

On May 10, the Surgeon-General issued the following order : 
"Regimental surgeons are requested to give officers and men in 
their commands instruction in first aid or self help, as the case 
may be, in the following subjects : Diet and drink in health 
and disease. Care of the person, bathing, clothing, feet, etc. 
What to do in sunstroke. Temporary treatment of fractures. 
Temporary arrest of hemorrhage. Transport of injured men. 
Application of first aid dressings. The illustrated triangular 
bandage will be furnished, to be displayed in a conspicuous 
place in company quarters so that every man may understand 
its application." 

These lectures were well attended and proved of signal value 
in preparing the line officers and men in the use of the first aid 
package, and in the prevention and treatment of hemorrhage, 
as well as enlightening them on the subjects of hygiene and 
sanitation. 

VACCINATION. 

On May 12, the Surgeon- General issued the following order : 

"To all surgeons and assistant surgeons : 

' 'Vaccination by regiments will take place as soon as they are 
mustered. You are directed to operate according to the fol- 
lowing rules, assisted by your hospital stewards : 

"1. The left arm is to be bared. A space four inches square 
at the outer border of the deltoid midway between its origin 
and insertion is to be thoroughly scrubbed with warm water 
and potash soap, then cleansed with alcohol and finally washed 
with pure water and dried with a pledget of absorbent cotton. 

"2. The arm is to be lightly scarified where cleansed for a 
space of one-half inch square. Both ends of the vaccin tube 
are to be broken off, and the virus blown on the wound with 
the rubber bulb furnished, and thoroughly rubbed in with the 
point of the lancet. The lancet is to be cleansed with alcohol 
after each scarification. 

"3. The arm is to be left exposed until thoroughly dry. A 
pledget of sterile cotton two inches square, is to be placed over 
the wound and held in place by an adhesive strap one-half inch 
wide and four inches long," 



21 



There is reason to believe that the above specific directions 
did much in the prevention of septic complications. 

CAMP DISEASES. 

The season of the year at which the troops were called out, 
the crowded condition of the camp, the imperfect equipment of 
the men, the continuous rain for over a week, and the change- 
able temperature were influences well calculated to test the 
strength and power of resistance to disease of the men who 
sought the service of the Government. 

The appearance of cerebro-spinal meningitis on the first day 
the troops were in camp in the case of a man of K troop, First 
Cavalry, excited much interest, and as this was followed in 
rapid succession by three additional cases in other commands, 
led to a thorough investigation as to the origin and spread of 
this disease. This investigation was conducted by Lieutenant 
Colonel' Kreider pursuant to an order from the Surgeon Gen- 
eral. Colonel Kreider presented the following report : 

Camp Tanner, Springfield, May 23, 1898. 
Colonel N. Senn, 

Surgeon-General, I. N. G., Camp Tanner, 111. 

Sir : — Pursuant to your order to investigate the origin and 
spread of the cases of cerebro-spinal meningitis which have 
occurred at this camp, I have the honor to report that up to 
this time three cases have appeared, all of which have resulted 
fatally. 

1. Ernest Royal Parish, of Troop K, First Cavalry. On my 
request, Major William Cuthbertson assigned to the First Cav- 
alry made the following report : "He was ailing for some days 
prior to enlistment. While waiting at Tattersall's at Chicago 
I have ascertained that he was compelled to lie down, but was 
up and able to pass inspection. He was taken violently ill on 
the train on the way down, with chills and vomiting. On 
reaching Springfield in the morning he was unable to walk and 
was removed to the Post Hospital on a stretcher. As soon as 
possible he was transferred from there to St. John's Hospital, 
where he now lies. I have just learned that another case of 
this disease exists at Western Springs, the patient's home." 
Parish died May 1. As stated in Surgeon Cuthbertson' s 
report, he had not placed a foot on the camp ground, and his 
stay there did not exceed half an hour. 



22 



2. Edward B. Beebe, of the Third Infantry, residing at 
Elgin, was sent to the Hospital May 13 by the Surgeon of the 
Regiment on. the eve of its departure, and was first seen by me 
on the following morning. In the afternoon I found him deli- 
rious, so that he required restraint and constant watching, 
which was given by a hospital steward of the Second Infantry. 
He died May 15. 

3. Robert Leland, of Third Infantry, residing at Ottawa, was 
first seen by me at the camp at 6 p.m.. May 14, and, as all am- 
bulances were in use, was conveyed in my buggy to the Hospital. 
Assistant Surgeon Lemke writes of the onset of the disease as 
follows : ' 'I saw him at noon, when he was complaining of intense 
headache. He became delirious the same night, although he was 
rational when aroused." The disease ran a very rapid course 
and death occurred May 17 at 11 p.m. From his family phy- 
sician I have learned that a sister aged 20 and a brother aged 
15 had died of tuberculosis. As ordered, I had intended hold- 
ing a postmortem on this case, but the body was removed 
from the Hospital at 2 a.m. by his father. 

The disease in the first case may be traced to other cases in 
his home town. He was not associated in any way with the 
men of the ThircJ Regiment, and it seems hardly probable that 
the disease could have been transmitted from him to the others. 
It seems probable that the disease in the Third Infantry was 
caused by the crowded and poorly ventilated quarters which 
this regiment occupied, or by the damp straw on which they 
slept. Each of these conditions was caused by the weather pre- 
vailing during the stay of this regiment at the camp. Because 
of the rains the men did not leave the building during the day, 
and thus the rooms became foul. I called the attention of the 
Surgeon of the Regiment to this foul odor early in the tour ; 
because of the rain also, the straw was brought in damp and 
may have figured in causing the trouble. 
Respectfully, 
[Signed] George N. Kreider, Post-Surgeon. 

Among the other camp diseases must be mentioned pneumo- 
nia, measles and mumps. The pneumonia contracted in the 
camp proved to be of an unusually malignant type. Of the 
thirty-two cases only two died, a mortality of about 6 per cent. 

Upon the outbreak of measles an isolated part of camp 



ground was selected for an isolation hospital, and placed under 
guard with a yellow flag in front of the hospital tent. Three 
cases of measles and three or four cases of mumps occurred. 
The patients were placed in separate hospital tents, and as soon 
as they recovered from the illness were subjected to a thorough 
disinfection and their clothing disinfected before they were 
allowed to return to duty. This isolation of patients suffering 
from infectious diseases proved effectual in the prevention of 
a further spread of the diseases. 

The ranks of the medical department were broken at an early 
date by the untimely death from pneumonia of Assistant-Sur- 
geon Cole of the Sixth Infantry, who was taken ill while 
en route with his regiment to Washington, and died at Fort 
Wayne, Ind. Upon reeeipt of the news of his death the medi- 
cal officers drew up the following resolutions : 

Whereas, By the untimely death of our comrade, Lieuten- 
ant L. S. Cole, Assistant Surgeon, Sixth Illinois Infantry, U. 
U. A., a career of brilliant promise has been cut short, be it 

Resolvedy That in the death of Lieutenant Cole the State of 
Illinois has lost a valuable medical officer and the medical 
profession an efficient and able member. 

Resolved, That we, the members of the Medical Department, 
of the Illinois National Guard and United States Volunteers at 
Camp Tanner, extend to his bereaved family and friends our 
condolence and sincere sympathy. 

Resolved, That copies of these resolutions be sent to his 
mother, and to his regiment. 
(Signed) 
T. J. Sullivan, Major and Surgeon Seventh Infantry. 
T. C. McCoRD, Major and Surgeon Fourth Infantry. 
Wm. CuTHBERTSON, Major and Surgeon First Cavalry. 
S. C. Stanton, First Lieut, and Ass' t. -Surgeon, I.N.G. 

Committee. 

With this communication my official connection with the 
National Guard of Illinois is temporarily severed, as I have 
been mustered in as Lieutenant- Colonel and Chief Surgeon, 
Sixth Army Corps, U.S.V., to be assigned to the command of 
Major General Wilson, Camp George H. Thomas, Chicka- 
mauga, Ga. 



AN OLD BATTLE GROUND. 

Chickamauga, June 3, 1898. 
Chickamauga ! What a terrible name to the reunited nation ! 
Here was enacted one of the bloodiest dramas in American his- 
tory. It is here where one of the most desperate battles of the 
War of the Rebellion was fought. Almost every foot of soil of 
this great National Park was stained with the blood of heroes 
on both sides. What a grand spectacle this beautiful park 
must have presented when it was the scene of one of the great- 
est battles known to history ! Two great armies composed of 
the same flesh and blood, face to face, engaged in a deadly con- 
flict. Upon the issup depended much on both sides, hence the 
heroism displayed and the terrible sacrifice of life. It seems to 
me I can hear now the beat of the drum, the shrill voice of the 
fife, the thundering roar of cannon, the rattle of musketry, 
the shouts of command, the groans of the wounded and the 
labored breathing of the dying. The bullet-riddled trees, the 
innumerable cannon occupying the same position as when they 
vomited forth fire, death and destruction, the many beautiful 
monuments and tablets commemorating the position of troops 
during action, and the places where distinguished leaders fell, 
are the silent witnesses of those awful days when our Nation 
was threatened by disruption and even death. It was no fault 
of our valiant enemy that the star spangled banner triumphed. 
The victory was dearly bought. Thousands of brave soldiers 
are resting in yonder cemetery. Many wounds inflicted still 
remain. Many an aged mother and father have had their life 
saddened by an irreparable loss sustained in that battle. Many 
an empty chair has remained in numerous lonely households. 
It will take more than another generation to wipe out the 
immediate consequences of the horrors of that battle. Let the 
present and all coming generations remember with veneration 
and true gratitude the heroic deeds enacted here. Years have 
gone by and this great park has become again the camping 
ground of a large army. Within a few weeks nearly fifty 
thousand men have pitched their tents and are making active 



25 



preparations for war. The hills, fields, woods and ravines are 
swarming with soldiers. Mounted oflBcers are galloping in all 
directions in clouds of dust. Brigades, regiments, companies 




and squads are hard at drill under the burniog sun. ISentries 
are stationed everywhere to preserve order, protect property 
and learn the art of watch dogs to protect the troops during 
the active campaign along the coast and in distant islands, the 



26 



the prospective fields of warfare. Almost every day new regi- 
ments arrive from every part of the country, often without 
arms and uniforms, but eager and ready to be instructed in 
the art of war. Our patriotic citizen soldiers in civilian drees 
envy their more fortunate comrades in showy blue, and impa- 
tiently await their turn to don the soldier's garb. It is refresh- 
ing and interesting to observe what patriotism will do in 
antagonizing the imperfections and hardships of camp life. 
Do you imagine you could hire many of these soldiers to do 
ordinary work under similar conditions at |5 per day? No ! 
Give them a uniform, a gun, and an opportunity to fight for 
the honor of their country and the glorious stars and stripes, 
and they rush to the front without a word of complaint, 
unconscious of the privations and hardships incident to the 
life of the soldier. 

SANITARY CONDITIONS. 

Chickamauga Park is admirably adapted for a large camp. 
It embraces several square miles. The forest trees furnish 
protection against the burning rays of the semitropical sun and 
the many open places and fields are utilized as drill grounds. 
Humus is scanty and the subsoil is of clay. The surface is 
somewhat undulating and is cut up here and there by ravines, 
which add much to the beauty of the scenery. An ample sup- 
ply of pure water is obtained from numerous wells, from 15 to 
65 feet in depth, recently supplemented by a pumping station 
which derives the water from the river, a short distance below 
Crawfish Springs, and distributes the water to different parts 
of the park through iron pipes. The vastness of the grounds 
are realized by the visitor as soon as he reaches George H. 
Thomas camp, which at the present time is occupied by nearly 
50,000 men, and yet seldom more than one regiment can be 
seen at one and the same time. In the past, Chickamauga has 
had an unenviable reputation as a health resort. The Indian 
name Chickamauga signifies literally "River of death." Along 
the banks of the Chickamauga river, which flows through the 
park, malaria was very prevalent years ago, which probably 
had something to do in inducing the Indians to designate this 
river by such a terrifying name. At the present time malaria 
has nearly disappeared from this part of the country, except a 
very localized district north of Crawfish Springs. The malaria 



27 



contracted in this circumscribed locality has been of a mild 
form and is probably due to the draining of a little pond on the 
south side of Park Hotel. 

An adequate number of sinks from four to eight feet in 
depth have been dug a safe distance from tents and field hos- 
pitals, all of which are boarded in. Three times a day the 
deposits in the sinks are covered with dry earth and ashes 
from the stoves and camp fires. One of the difficulties so 
constantly prevailing in camps has been the introduction of 
harmful articles of diet by interested friends and enterprising 
merchants. The regulations governing this evil are becom- 
ing more and more stringent and are more effectively carried 
out, so that the danger from this source is diminishing pro- 
gressively. 

PREVAILI^'G CAMP DISEASES. 

The most common disease affecting the troops at this time is 
diarrhea. The continuous heat, the change and often impru- 
dence in diet and sleeping on the ground are the most impor- 
tant etiologic elements. The last mentioned cause becomes 
apparent from the fact that the privates are much more fre- 
quently affected proportionately than the commissioned officers, 
most of whom enjoy the luxury of a cot. A number of deaths 
have occurred from cerebro spinal meningitis, more especially 
among the Illinois troops. In my first communication I traced 
the disease to Camp Tanner, where it originated from a case 
brought there by the first regiment of cavalry. A few days 
ago Capt. Lemke, 3rd Regiment Illinois Volunteers, made a 
postmortem examination at the 1st Division Hospital, 1st Army 
Corps, which demonstrated the pathological appearances of 
the disease to perfection. There was a difference of opinion in 
reference to the location and nature of the disease, as during 
the early history of the case the symptoms referable to the 
cerebro-spinal centers were conspicuous, while later a compli- 
cating pneumonia masked the manifestations of the original 
disease. The examination showed croupous pneumonia involv- 
ing one lobe of the lung, of recent origin, while the meninges 
of the brain and spinal cord presented all the evidences of an 
acute inflammation. The lining membranes of all the ventricles 
were involved. The pathological changes were most marked 
at the base of the brain and more especially the pons Varolii 



28 



and medulla oblongata. In these localities the meninges were 
found infiltrated and covered with a plastic exudate. 

The remaining portions of the membranes enveloping the 
brain and cord were extremely vascular and in some places 
presented an opalescent appearance. A considerable quantity 
of turbid serum was found in the ventricles and subarachnoid 
space. It was evident from the postmortem appearances that 
the primary disease involved the nervous centers and that the 
lobar pneumonia set in later as a complication and contributed 
toward an early fatal termination. Two cases of cerebro spinal 
meningitis, presenting grave symptoms observed in Camp 
Tanner, improved promptly after lumbar puncture and I have 
been subsequently informed that both of these cases ultimately 
recovered. The first tapping was made by Lieut. Rowe of the 
1st Illinois Cavalry, All cases of cerebrospinal meningitis 
that have been sent to the Division Hospital have been placed 
in isolation tents for the purpose of preventing further spread 
of the disease. Measles has broken out in the camp and all 
patients suffering from this disease, about twenty in number, 
at the present time are under guard in isolation tents. The 
disease is mild in type, the patients as a rule being confined to 
bed not longer than four or five days. Pneumonia has been 
prevalent, especially among the regiments from the northern 
States. Delirium is usually absent although the disease other- 
wise has assumed a grave type. In several fatal cases the 
postmortem changes indicated that death resulted from sec- 
ondary streptococcus infection. At the present time there are 
only three or four cases of typhoid fever in camp and in most 
of them it is more than probable that the disease was con- 
tracted before the patients reached the camp. Considering 
the inadequate clothing of many of the volunteers, the heavy 
dew and the chilliness experienced some nights, it is remarka- 
ble that so few suffer from rheumatism and bronchitis. Sun- 
stroke and heat exhaustion have so far not visited the camp, 
although heavy marching and active drilling often take place 
with the sun high up in the horizon. On the whole the health 
of the troops is excellent. 

A TIMELY BENEFACTRESS. 

As soon as I arrived at Camp George H, Thomas I called on 
Lieut. Col. Hartsuff, U. S. A., who received me very kindly 



29 



and spent nearly half a day in showing me the location of regi- 
ments and field hospitals. His experience since he took charge 
of the medical affairs of the camp had taught him that the 
hospital facilities even with the limited number of sick at the 
present time were entirely inadequate. Near the park and on 




30 



the south side of it, adjacent to the famous Crawford Springs is 
a large well built hotel containing seventy rooms, which had 
recently been evacuated and on which he had an option for a 
few days, purchase price $10,000. The building alone cost 
$65,000 and as the purchase price included the entire furni- 
ture, water privilege and four acres of land, and the building 
was in a condition that it could be occupied at once without 
much repair he had strongly recommended its purchase for 
hospital purposes to the Surgeon-General. There was no ques- 
tion as to the desirability of acquiring the property to better 
and increase the hospital facilities ; neither could there be any 
doubt of the government's willingness to buy it to meet the 
existing emergency, but past experience satisfied all concerned 
that it would take weeks, and perhaps months, before the 
building could be made available by relying on the routine way 
in acquiring the property. Recognizing the necessity for imme- 
diate action in the premises and the fact that the option was 
open only for a few days, at the expiration of which the owners 
intended to reopen the hotel, I asked permission of Col. Hart- 
suff to allow me to make an attempt to secure the building by 
donation and later present it to the Government. This 
request was willingly granted. I telegraphed to Mrs. L, Z. 
Leiter, Washington, D. C, the condition of affairs and in due 
time received the pleasing information by wire from her hus- 
band that I should proceed at once and draw on him for the 
amount. After overcoming some of the technical difl&culties 
in the way of securing the necessary water supply from the 
adjacent Crawfish Springs, the purchase was made and the 
'Leiter Hospital" has become a beautiful monument to the 
memory of a distinguished family that has given the first large 
donation for the benefit of our sick citizen soldiers at the very 
beginning of the Spanish- American war. May this noble 
example find many imitators ! 



Chickamauga, Ga., June 22, 1898. 

CAMP GEORGE H. THOMAS. 

From early dawn until taps, Camp Thomas is the scene of 
a busy, active life. It is the gathering point of the largest 
army concentrated in one place since the War of the Rebellion. 
It is at the present time the temporary home of 45,000 men 
representing almost every State in the Union. Many of the 
regiments are short of their quota, and recruits to the number 
of 500 on an average arrive daily to complete the organization of 
the regiments now in camp. The commander of the whole 
army in camp is Major General John R. Brooke, General in 
Chief in charge of the Department of the Lakes. He came 
here from Chicago with his entire staff. He enjoys the repu- 
tation of being a strict disciplinarian who does everything 
through the legitimate military channels. The greatest sour- 
ces of confusion and consternation to the officers of the vol- 
unteers from civil life are these mysterious military channels 
which extend from the General's tent to the heads of the 
many departments in Washington. One of the blue books in 
constant use by officers, high and low, young and old, is the 
U. S, Army Regulations, 1895. The thousands of questions 
asked the professional soldier daily by his less informed volun- 
teer officer are answered more often than otherwise by " Study 
the Regulations, Study the Regulations, Study the Regula- 
tions." Such advice, as a rule, is more easy to give than to 
follow with any expectation of approval at headquarters. The 
experience here has satisfied me more than ever that the Na- 
tional Guard officers need more thorough training in execu- 
tive, clerical work, so essential in the efficient management of 
troops at home and in the field. One of the common sights 
in camp is to see an officer hide himself away under a solitary 
tree and pore over a work on tactics or the much feared "Reg- 
ulations." If this war does nothing else but demonstrate 
to our people and to the legislators, State and National, 
the necessity of a well-organized militia it will have accom- 
plished a great deal. If we had in this country, as we 



32 



ought to have, a well organized, well equipped militia force of 
200,000 men, we would have been in possession of all the Span- 
ish islands and Spain itself, if we wanted it, long ago. As it 
is, it takes two millions a day and the hardest kind of work to 
bring our volunteers into fighting trim. The officers of the 
regular army have reason to be thankful to Spain for having 
given them a chance to fight. They have been looking a long 
time anxiously for such an opportunity. They are the recog- 
nized salt of the army. The Government has fully recognized 
their claims. Nearly every day the newspapers bring columns 
of names of lucky officers who have been advanced in rank, in 
fact it seems almost impossible for any one of them to escape 
promotion of some kind. This is probably as it should be, but 
occasionally such promotions lead to giddy heights. To make 
a lieutenant- colonel out of a second lieutenant of very limited 
practical experience is a transition of doubtful propriety and 
often followed by the most detrimental results, both to the 
over-ambitious officer and the over-confiding troops placed 
under his charge. Officers thus honored by promotion and 
assigned to the army of volunteers are, as a rule, more anx- 
ious to change the shoulder straps than to add the V. to the 
U. S. on the collar of the blouse. On the whole, the regular 
army officers are perfect gentlemen and great favorites in the 
camp, and the feeling between them and the officers from civil 
life is of a most cordial nature. 

The First Army Corps under General Brooke is nearly com- 
pleted. The Third Army Corps under command of Major- Gen- 
eral Wade is nearing completion. The Sixth Army Corps is 
soon to be organized under Major-General James H. Wilson. 
General Wilson gained an enviable reputation during the late 
war as a dashing cavalry officer and will undoubtedly make a 
creditable record during the present war if it lasts long enough 
to bring his army into the field, Lieut. -Colonel Hartsuff, an 
experienced medical officer of the regular army, is Surgeon-in- 
Chief of the army gathered here, and as such is attached to 
the staff of General Brooke. Lieut. -Colonel Van Hoff is Chief 
Surgeon of the Third Army Corps, and has worked incessantly 
in completing the organization of the medical department under 
his supervision. He is regarded as one of the ablest executive 
officers of the medical service, and is known as a warm friend 



33 



of the medical officers of the National Guard. He has from 
the very beginning taken a deep and active interest in the work 
of the Association of Military Surgeons of the United States. 
Every medical officer of the Third Army Corps should con- 




Major-General John R. Brooke. 
General in Chief in charge of the Department of the Lakes. 

sider it a great privilege to serve under Lieut. - Colonel Van Hoff. 
The medical department of the First Army Corps is in charge 
of Lieut. -Colonel Heidekoper of New York, a hard-working, 
conscientious officer. Major Kimball of Marion, Ind., and Ma- 



34 



jor Woodbury of New York, have reported here and are await- 
ing with the writer the formation of the Sixth Army Corps. 
At present my time is profitably occupied by consultations in 
the camp and by performing operations in the Leiter General 
Hospital and the St. Vincent's Hospital, Chattanooga. The eve- 
nings are occupied by giving lectures on first aid to the Hospi- 
tal corps. St. Vincent's Hospital has been used as a tempo- 
rary hospital for the troops until the Leiter Hospital was in 
condition to receive patients. The abandonment of regimen- 
tal hospitals meets with the same opposition here as elsewhere, 
but the wisdom of such a course must be apparent to all who 
have had experience in the field. Major E, C. Carter, U. 
S. A., is now in charge of the Leiter General Hospital. He is 
one of the busiest men in the camp. He is in every way ad- 
mirably adapted for the position he now occupies. He is 
straining every nerve to improve and equip the building for the 
accommodation of from 300 to 500 patients. He has the hearty 
co-operation of the Surgeon-General and Colonel Hartsuff 
in pushing the work. About thirty patients are at present in 
the hospital and in less than two weeks the number of patients 
will exceed one hundred. Hospital furniture and supplies are 
arriving every day, and in the course of two weeks the hospi- 
tal will be fully equipped. The value of this hospital to our 
sick soldiers can not be overestimated. Mrs. Leiter will have 
the respect and sincere gratitude of every one of the inmates 
and of hundreds yet to come, Chickamauga is a quiet little 
country hamlet where our patients can enjoy to the fullest ex- 
tent what they are so much in need of, rest and quietude. Six 
trained nurses have been sent by the Surgeon- General and are 
now on duty. With the increase in the humber of patients 
more will be sent. A corner room in the tower on the second 
story has been set aside as an operating room and is now under- 
going the necessary repairs to adapt it for this purpose. The 
first operation performed in this hospital was for empyema 
following pneumonia. Two additional cases await a similar 
operation during the course of the week. 

CRAWFISH SPRINGS. 

One of the great attractions near the National Park and 
adjacent to the Leiter General Hospital is the famous Crawfish 
Springs. At the end of a large basin and at the base of a rock 



35 



a large volume of water, as clear as a crystal, is poured out 
with considerable force. This spring yields 62,000,000 gallons 
of water in twenty-four hours. The temperature of the water 
is 56 degrees F. , summer and winter alike. The dam a little 




Maior-General James H. Wiison. 

below the springs, utilized to furnish water power for the hotel, 
has been removed for the reason that it interfered with the 
supply of water, deviating it evidently through subterranean 
channels in another direction. As soon as the property was trans- 
ferred to Mrs. Leiter for Government use I had the basin cleaned 



36 



out of moss and dirt by a detail of soldiers furnished by the 
Fifth Illinois Infantry. The sides of the hill around the basin 
were ditched a few feet above the level of the water for the 
surpose of draining the surface water to a safe distance below 
the springs. The Hospital is supplied with water from this 
spring. Besides, hundreds of barrels of water are brought daily 
into the camp by mule teams. The water is wholesome and 
palatable. 

The following is the result of a chemical analysis made by 
a competent chemist : 

ANALYSIS OF CRAWFISH SPRINGS WATER. 

Bicarbonate of lime 0.6753 

Bicarbonate of magnesia 0.4544: 

Sodium chlorid 0.856 

Potassium chlorid 0.048 

Silica 0.0537 

Free ammonia 0.0029 

Albuminoid ammonia 0.0025 

Oxygen absorbed. 0.031 

The presence of free ammonia and albuminoid of ammonia, 
although small in quantity, led us to suspicion the presence of 
organic matter which might possibly prove to be a source of 
danger. For the purpose of testing the water still further as 
to its fitness for hospital and camp use, samples were sent at 
three different times to the professor of chemistry in the Chat- 
tanooga Medical College. Dr, H. Berlin made a very careful 
chemic analysis and bacteriologic examination with the result 
that he pronounced the water free from dangerous organic 
matter and pathogenic microbes. The only microbe which he 
was able to cultivate was the colon bacillus, and the presence 
of this microbe could be readily accounted for by the blocking 
of the sewer pipe, an evil which was promptly removed. The 
springs would furnish an ample water-supply for the whole 
army if the Government would only erect a pumping station 
near it, a project which is now under serious consideration. 
With such an improvement Camp George H. Thomas would be 
one of the most salubrious camping places in the United States 
for a large army. The intake now is some distance below the 
springs where the flow of water is impeded by a dam two miles 
and a half below the springs. Above the dam is a narrow 



37 



beautiful lake two miles and a half in length, extending to near 
the springs, which is leased by the Chickamauga Fishing Club. 

CHATTANOOGA MEDICAL SOCIETY. 

This medical society meets twice every month, on the first 
and third Friday. At the last meeting the subject selected by 
the committee was "The Modern Treatment of Gunshot 




Major-General Joseph C.Breckinridge. 
Wounds in Military Practice." The writer was invited to open 
the discussion. After a brief resume of the character of wounds 
inflicted by the modern bullet, the treatment was considered 
in detail. Special stress was placed upon the inutility of the 
ordinary and Nelaton's probe in locating and finding bullets 
lodged in the body. Attention was called to the value of the 



X ray as a substitute for the probe in making a reliable diag- 
nosis. The use of the bullet probe on the battlefield ^as con- 
demned and the advice given that bullet wounds should be 
hermetically sealed with the first aid package, which should con- 
tain an antiseptic powder composed of boracic acid and salicy- 
lic acid (4 :1), and no exploration made until the patient reaches 
the field hospital, where all facilities for aseptic surgery and 
the necessary instruments for diagnosis and operation should 
be at hand. A new bullet probe and bullet forceps devised by 
the writer were exhibited and their manner of use explained. 
The balance of the paper treated of gunshot wounds of the 
extremities, cranium, chest and abdomen. For want of time 
consideration of the last subject, "Gunshot Wounds of the 
Abdomen," was postponed until the next meeting. Invitations 
to attend the meeting were sent to the military surgeons in 
camp, consequently the attendance was large and the discus- 
sion became general and proved of interest to all present. 
Considering that Chattanooga has only 40,000 inhabitants and 
that the average attendance at these meetings on ordinary oc- 
casions is never less than from thirty-five to forty, is the surest 
indications that our colleagues in this city take an active 
interest in the scientific work of the profession. 

AMUSEMENTS. 

The civilian soldier finds it difficult to satisfy his mind and 
body with what is required of him in camp life. But a few 
weeks ago he was a professional man, a clerk, teacher, or left 
the school, workshop and plow, and now it is hard for him to 
imagine that he should not be kept busy from sunrise to sunset. 
He is only too anxious to drill in sunshine or rain, and considers 
it a privilege to do guard duty, where his power and military 
significance can be made to appear at greatest advantage. He 
finds it difficult to occupy his many leisure hours in a profitable 
manner. To the credit of our soldiers it must be said that 
evidences of intemperance are rarely seen in camp. Temperance 
canteens are common and are better patronized than those in 
which beer is sold. I have not seen an intoxicated soldier since 
I arrived in camp. The more common amusement of the soldiers 
during the heat of the day, between 10 a.m. and 3 p.m., between 
drill hours, consists in reading, writing letters, playing cards, 
and the college boys are bound to play base- or football. The 



39 



chaplains make themselves useful not only in caring for the 
spiritual welfare of their soldiers, but they also look after their 
intellectual interests. They extemporize reading-rooms and 
supply them with writing and reading material. These reading 
tents are very popular, and when the men are off duty they are 
always crowded. The many regimental bands furnish excellent 
music, which does so much in cheering up and amusing the 
soldiers. Two theaters have sprung up in the camp, mushroom- 
like. Performances are given in the afternoon and evening. 
The admission fee is twenty-five cents, box seats fifty cents. I 
have been told by those who have been in the habit of attending 
that the plays are good and that the patrons are made to feel 
that they have received their money's worth. 

RED CROSS ASSOCIATION. 

The Medical Department during the present war is in a con- 
dition fairly well prepared to supply the sick and wounded with 
the necessary instruments, medicines and food. There will be 
only a very limited field of usefulness for the Red Cross Asso- 
ciation to fill in defects here and there as occasion and circum- 
stances may require. The work of the Red Cross Association 
is, however, recognized by the War Department, as becomes 
evident from a circular letter received a few days ago from the 
Surgeon- General : 

Surgeon- General's Geeice, Washington, June 9, 1898. 
Lieutenant- Colonel Nicholas Senn, Chief Surgeon U. S. Vol- 
unteers, Sixth Army Corps, Chickamauga Park, Ga. 
Sir: — The Secretary of War has approved the following 
proposition made by the American National Red Cross Associ- 
ation, and the chief surgeons of the Army corps and divisions 
will co-operate with the authorized agents of this Association 
for the purposes indicated : 

*' We can put any desired amount of hospital supplies — ice, 
malted milk, condensed milk, Mellin's food, etc., into any of 
the volunteer camps in a few hours. Will you be kind enough 
to bring this letter to the attention of Secretary Alger and ask 
him if there is any objection to our appointing a Red Cross 
representative to report to the commanding officer and the 
chief surgeon in every camp, confer with them as to their 
immediate needs and, if anything of any kind is wanting, open 
there a Red Cross station and send in the supplies. We can 
do this, not in a few weeks or a few days, but in a few hours, 
and can furnish any quantity of any desired luxury or delicacy 
for hospital use. We hereby tender our aid and put our organ- 



40 



ization at the War Department' s service for co-operation in the 
field." Very respectfully, 

Geo. M, Sternberg, Surgeon- General U. S. A, 

It was prudent and wise that the Surgeon-General and the 
Secretary of War granted this modest request. Dr. Gill of 
New York represents the Red Cross Association here. He 
arrived a few days ago and intends to erect a frame building 
near the general headquarters as a storehouse for the supplies. 
He possesses excellent executive abilities combined with mod- 
esty, which will ensure him a wide avenue of usefulness and 
the hearty appreciation of the medical officers. In my next 
communication I will speak of the hospital corps, its organiza- 
tion and scope of work in actual warfare. 



ASSIGNED TO A NEW FIELD. 



War always has been and always will be a cruel thing. The 
very object of war is to kill, disable, maim and starve until the 
result of the contest shall decide the issue by demonstrating 
the superiority of one army over the other in number, courage 
or skill of warfare. " The battle is the Lord's," but victory is 
not always on the side of justice. The Lord teaches, rules and 
benefits the children of men now, as during the time of the 
prophets, as often by defeat as victory. The God of battles 
has ways and means often impossible to comprehend, but they 
always lead to results beneficial to mankind. The terrors and 
sufferings of war are the prices paid for defeat as well as vic- 
tory. The wonderful improvements made in weapons and pro- 
jectiles during the last quarter of a century have made modern 
warfare more destructive if not less cruel. It is difficult to 
foretell the relative number of dead and wounded in the engage- 
ments of the future. Reliable information on the subject must 
come from actual observation on a large scale on the battlefield 
and not from the results of experiments on the lower animals 
and the cadaver. Warfare has become a science and an art, 
and victory will depend as much on the skill and foresight in 
strategy of the commanding officers as the endurance and valor 
of the troops. The long range rifles and the better marksman- 
ship of the average soldier will increase the distance between 
the fighting lines and give the commanding officers better 
opportunities for the exercise of their skill in maneuvering the 
troops. In every respect war will and must assume more sci- 
entific aspects for the display of skill. What the improve- 
ments will be can only be determined by experience on a large 
scale. The rapid mobilization of troops, supply of ammunition 
along the line of battle, flank movements, the quick digging 
of shallow entrenchments for the protection of the soldiers in 
line of battle, are some of the important subjects which are 
engaging the minds of our wide awake military officers and 
which await a satisfactory solution by as yet an unknown 



42 



second Napoleon. Let us hope that this important person is 
now in existence, an American citizen and now engaged in the 
present war with Spain. 

HOSPITAL CORPS. 

The humane side of the present methods of warfare is best 
shown by the organization of an efficient hospital and ambu- 
lance corps. The sick and wounded of the great war of the 
rebellion suffered indescribable pain and agony owing to inad- 
equate provisions for transportation, first aid and nursing by 





Private, hospital corps U.S. Army, 
field equipment (front view). 



Private, hospital corps U.S. Army, 
field equipment (rear view). 



men detailed for this special purpose. Our sick and wounded 
can look forward more hopefully for more prompt and efficient 
treatment. The Government, through the Surgeon- General 
and Secretary of War, is making ample preparations for the 
prompt and efficient treatment of those requiring medical or 
surgical aid. The prevention of disease by the employment of 
improved hygienic and sanitary measures will do much in 



43 



minimizing the number of ignominious deaths in the field and 
general hospitals and in maintaining the full fighting force. 
The need of a well organized and well equipped hospital corps 
became apparent during our late war, but it was many years 
after the Union was restored before the necessary legislation 
was effected which brought it into existence. The Hospital 
Corps in the United States Army was created by an act of 
Congress approved March 1, 1887. 

The law under which the Hospital Corps was established 
and as revised by March 16, 1895, and March 16, 1896, reads as 
follows : 

(The Military Laws of the United States, 1897.) 

"673. That the Hospital Corps of the United States Army 
shall consist of hospital stewards, acting hospital stewards and 
privates ; and all necessary hospital services in garrison, camp 
or field (including ambulance service) shall be performed by 
the members thereof, who shall be regularly enlisted in the 
military service. Said Corps shall be permanently attached to 
the Medical Department, and shall not be included in the 
effective strength of the Army nor counted as a part of the 
enlisted force provided by law. 

"674. That the Secretary of War is empowered to appoint 
as many hospital stewards as, in his judgment, the service may 
require ; but not more than one hospital steward shall be sta- 
tioned at any port or place without special authority of the 
Secretary of War. That there shall be no appointments of 
hospital stewards until the number of hospital stev/ards shall 
be reduced below one hundred, and thereafter the number of 
such officers shall not exceed one hundred. 

"675. That the pay of the hospital stewards shall be forty- 
five dollars per month, with the increase on account of length 
of service as is now, or may hereafter be allowed, by length of 
service, as is now or may hereafter be allowed by law, to other 
enlisted men. They shall have rank with ordnance sergeants 
and be entitled to all the allowances appertaining to that grade. 

"676. That no person shall be appointed a hospital steward 
unless he shall have passed a satisfactory examination before 
a board of one or more medical officers as to his qualification 
for the position, and demonstrated his fitness therefor by 
service of not less than tweive months as acting hospital stew- 
ard ; and no person shall be designated for such examination 
except by written authority of the Surgeon-General. 

"677. That the Secretary of War is empowered to enlist or 
cause to be enlisted, as many privates of the Hospital Corps as 
the service may require, and to limit or fix the number, and 
make such regulations for their government as may be neces- 
sary ; and any enlisted man in the army shall be eligible for 



44 



transfer to the Hospital Corps as a private. They shall per- 
forEQ duty as wardmasters, cooks, nurses, and attendants in 
hospital, and as stretcher-bearers, litter-bearers and ambu- 
lance attendants in the field, and such other duties as may by 
proper authority be required of them. 

"678. That the pay of privates of the Hospital Corps shall 




Litter drill. 

be eighteen dollars per month, with the increase on account of 
length of service as is now or may be hereafter allowed by law 
to other enlisted men ; they shall be entitled to the same allow- 
ances as a corporal of the arm of service with which on duty. 
"679. That privates of the Hospital Corps may be detailed 
as acting hospital stewards by the Secretary of War upon the 
recommendation of the Surgeon-General whenever the necessi- 



45 



ties of the service require it ; and while so detailed their pay 
shall be twenty -five dollars per month, with increase as above 
stated. Acting hospital stewards, when educated in the duties 
of the position, may be eligible for examination for appoint- 
ment as hospital stewards as above provided." 

Since the original law providing for a hospital corps was 
passed many new features have been added which have made 
this branch of the military service more efficient. 

The pay of members of the Hospital Corps is according to 
grade, as follows per month : Hospital steward, $45 ; acting 
hospital steward, $25 ; private, $18. 

To the rates of pay enumerated above, 20 per cent, is added 
in time of war. 

During the present war the commander of an army corps, or 
of a division, or of a brigade acting independently of a corps, 
has full control of enlistments for the Hospital Corps within 
his command, and of the detail of acting hospital stewards and 
the appointment of hospital stewards. The Hospital Corps 
force of the present war is made up three per cent, of the pri- 
vates obtained by special enlistment or transfer from the line, 
that is, a regiment of 1000 men is entitled to 30 men for the 
Hospital Corps. The allowance for horses, wheel transporta- 
tion and tentage is ample, as will be seen from the following 
order recently issued by the War Department : 

General Orders.) HEADQUARTERS OF THE ARMY, 

V Adjutant General's Office, 

No. 76. ) Washington, June 22, 1898. 

1.— By direction of the Secretary of War, the following allowance of 
horses for mounts, wheel transportation, tentage, etc., for the Medical 
Department of the Army in the field is authorized : 
Horses for Mounts. 



To each 
To each 

teries) 
To each 
To each 
To each 
To each 
To each 
To each 

pany . 
To each 
To each 



regiment of infantry 

artillery battalion (3 light bat- 



cavalry regiment 

corps headquarters 

division headquarters .... 

brigade headquarters 

division ambulance company, 
corps reserve ambulance com- 



division field hospital . . 
corps reserve hospital . . 



Hospital 
stewards. 



Acting 
hospital 
stewards. 



Privates. 



1 
2 
2 
1 

1 
12 

12 
6 
6 



Wheel transportation.— One ambulance to 400 men of the effective force. 
One 4-horse wagon to 600 men of the effective force. One 4-horse wagon 
to each brigade. 



46 



Tentage. — For each ambulance company: 17 commion tents for pri- 
vates; 2 common tents for noncommissioned officers. For each divi- 
sion field hospital: 15 common tents for privates; 2 common tents for 
noncommissioned officers ; 1 common tent for supplies. Hospital tents 
on a basis of 6 patients (beds) to each tent. Hand litters, with slings, 
to be furnished by the Quartermaster's Department: 1 for each com- 
pany; 2 for each ambulance. 

Requisitions for the necessary articles of camp and garrison equipage, 
tools, etc., will be based on the official allowances for companies of 
infantry. 

Requisitions for the before mentioned supplies will be sent in sep- 
arately for divisions ^vfifh statement whether or not the division organi- 
zation is complete. 

Horses and wheel transportation will be furnished by the Quarter 
master's Department, and horse equipments by the Ordnance Depart- 
ment. 

II.— Commanding Generals of Army Corps are directed to detail, upon 
the application of Chief Surgeons of Corps, two officers not above the 
grade of first lieutenant for duty as Acting Assistant Quartermasters 
with the medical service of each division. 

By Command of Major General Miles: 

H. C. CORBIN, 

Adjutant General. 




Litter drill. 
As usual, many difficulties have presented themselves in the 
way of securing the necessary material both in quantity and 
quality, for the Hospital Corps during the present campaign. 



47 



The commanding officers are always averse to lose the most 
desirable men of the line. I have reason to believe that at the 
present time the importance of a good Hospital Corps is appre- 




Travois. 

ciated more than ever by the commanding officers. The field 
officers have co-operated with the corps surgeons in the selec- 
tion of the best men for this special service. The work of 
organization has progressed slowly, but on the whole in a sat- 



48 



isfactory manner. The enormous demand for equipments and 
the sudden mobilization of troops have contributed much in 
retarding the organization and instruction of the Hospital 
Corps. The designation of the Corps as a Hospital Corps does 
not convey the proper meaning of the manifold purposes for 
which the men are enlisted and transferred, and has been the 
means of misleading many a patriotic doctor and medical stu- 
dent now engaged in this branch of military service. Many 
complaints are heard because instead of doing hospital duty 
proper the men are made to cook, drive ambulances, chop wood, 
dig sinks and haul water. There are today too many doctors 
and medical students in the Hospital Corps. The duties of 
the Hospital Corps are manifold, and in their proper discharge 
requires more skilled artisans than medical men. A good Hos- 
pital Corps should consist largely of young, bright, intelligent, 
robust men skilled as carpenters, cooks, blacksmiths, stenog- 
raphers, photographers, ambulance drivers, tailors, shoemakers 
and other trades. Doctors and medical students should be in 
the minority, and ought not to exceed twenty-five per cent, 
of the non-combatant force. If the legitimate function of 
the Hospital Corps were better understood there would be 
fewer applications for this service on the part of profes- 
sional men. The general impression prevails that the duties 
of the members of the Hospital Corps are less onerous 
than those of the private soldier of the line. It is difficult to 
conceive how such an idea could have originated. It is also 
understood that the non-combatant soldier is exposed to less 
risk of life than his comrade of the line, when the fact is ap- 
parent that in addition to the ordinary dangers incident to 
warfare, he is more exposed to the greatest source of danger — 
disease. The nursing in the field hospital is done exclusively 
by the Hospital Corps men, and involves much loss of sleep 
and constant care and attention. The transportation of sick 
and wounded is a task requiring good judgment, promptitude 
and care. A combination of firmness and gentleness, thought- 
fulness of action and a determination to perform duty regard- 
less of rest and comfort, is an essential element of success in 
the work of every Hospital Corps man. The climatic influence, 
the prevalence of tropical diseases will tax to the utmost the 
resources of the Hospital Corps during the present war with 



49 



Spain. That the work will be well and cheerfully done I have no 
doubt, j udging from my observations during the last two months. 
The American, people expect that the sick and wounded of 
this war shall receive the best possible attention, and in this 
they will not be disappointed. The Government, although 
sometimes necessarily tardy, is willing and anxious to do all 
in its power to alleviate the horrors of this war, and in this 
humane intention it will receive the hearty co-operation of the 
Hospital Corps. The writer has been permanently detached 
from the Sixth Army Corps now at Chickamauga by a recent 
order, and is now on his way to Santiago de Cuba on special 
duty. He goes to the front as Chief of the Operating Staff 
with the troops in the field. For the purpose of informing my 
many friends among your readers what I am expected to 
do, I append a copy of the letter assigning me to my new field 
of labor. 

HEADQUARTERS OF THE ARMY. 

Washington, D. C, June 29, 1898. 
Lieutenant-Colonel Nicholas Senn, U. S. V., Chief of the 

Operating Staff. 

Sir:— In assigning you as Chief of \he Operating Staff, the 
Major General Commanding the Arn^y directs me to say that, 
at the several points to which you may be assigned to duty, 
you will confer with the Chief Surgeon of the Corps engaged 
as to the means by which you may consult with and advise the 
medical officers serving with that army regarding the clinical 
features of their professional work ; that you will recommend 
such methods, either by lectures or operative demonstration, 
as may in your judgment be best suited to accomplishing the 
purpose in hand ; that you will take the necessary steps for 
collecting data upon which the clinical and pathologic records 
of the field and hospital service may be classified, and from 
which the future medical and surgical history of this war may 
be prepared. Your present assignment will be for duty with 
the Fifth Army Corps, now operating before Santiago de Cuba, 
and at such future time as the General Commanding may 
decide, you will be transferred to other points where active 
military operations are progressing. 

Very respectfully. 

Col. Chas. R. Greenleae, 
Asst. Surg.-Genl. U. S. A., Chief Surgeon, Army in the Field. 

I hope I will reach Santiago before surrrender and enter it 
with our victorious troops. My address for the present will be 
Fifth Army Corps, Santiago, Cuba. 

My next communication will be from the seat of war. 



THE FLOATING HOSPITALS. 

Off Santiago de Cuba, July 7, 1898. 
The government, the different charitable societies, local. 
State and general, and the people, have from the very begin- 
ning of this war vied with each other in adopting and carrying 
into effect means and measures to provide comfort and efficient 
treatment for the sick and wounded. A commendable unity 
and harmony of action prevails throughout the entire country 
to bring about the best results. Desultory action, so common 
during the War of the Rebellion and that did so much in 
retarding the philanthropic work at that time, has largely 
given way to well organized, systematic efforts which will be 
sure to result in the greatest amount of good to all in need of 
such assistance. The patriotism of the people is only equaled 
by their generosity to those who are now engaged in the 
defense of the honor and dignity of their country. The out- 
side world will watch the progress and extent of the humani- 
tarian work displayed during this war with as keen an interest 
and degree of admiration as the victories of our army. The 
collection and distribution of funds, clothing, delicacies and 
hospital supplies is in the hands of responsible persons, and 
the liberal donors can be assured that the articles contributed 
will reach the intended destination. . Many of the railway cor- 
porations have shown a laudable willingness to forward con- 
tributions of this kind at greatly reduced rates, a concession 
which will materially increase the usefulness of the various 
societies which have been or will be organized throughout the 
land for the distinct purpose of aiding the government in prop- 
erly caring for those who have been disabled from injury or dis- 
ease. Efforts in this direction are best calculated to stimulate 
the patriotism and heroism of our soldiers in the field. One of 
the noblest undertakings for this purpose is the action of the 
government in the recent purchase and outfitting of two large 
ocean vessels for hospital and ambulance use. The Navy has 
the Solace^ and the Relief, now under sail for the seat of war, 
is intended for the Army. The seat of war makes the use of 



51 



these ships an absolute necessity for the proper care of the 
sick and wounded. Both of these ships are floating hospitals 
supplied with all the facilities of a modern hospital. 

The Hospital Ship ''Relief.'' — This communication is written 
on board the hospital ship Relief, on its first trip to the seat 
of war. The ship started from New York, July 2, and called 
at Fortress Monroe in the afternoon of the following day for 
the purpose of taking on board a number of surgeons, inclu- 
ding the writer. Surgeon General Sternberg awaited her arri- 
val, and made a thorough inspection before her departure. 
The name of the ship appears particularly appropriate from the 
conditions under which we left Fortress Monroe, Sunday, July 
3. Shortly before leaving Fortress Monroe cable messages an- 
nounced that fierce fighting was in progress on the third day 
of the battle of Santiago. They also announced to the anx- 
ious crowd that gathered around the bulletin boards at the 
hotel Chamberlin, that the number of killed and wounded on 
our side had reached the neighborhood of 1200, and that the 
enemy showed greater strength and resistance than had been 
anticipated. General Shafter, in command of the invading 
army, had sent a telegram to New York asking for the imme- 
diate despatch of the Relief. There can be no doubt but 
that the appearance of the boat is eagerly looked for at the 
seat of war, and that upon her arrival she will merit the name 
she bears. The Relief was formerly the John Englis, and was 
purchased by the Government, some six weeks ago, from the 
Maine Steamship Line, for $450,000. She was the sister ship 
of Horatio Hall, and was used a year and a half as a coast 
liner between New York and Portland, Maine. She was built 
by the Delaware River Iron Ship Building and Engine Works, 
Chester, Delaware, in 1896. She was well adapted for the 
coast service, and it was a rare opportunity when she was 
secured for Government service. The vessel is 300 feet in 
length, 46 feet in width, draws 15 feet of water forward and 
163^ feet aft, and has an average speed of 14 knots an hour. 
She carries two masts, one smoke-stack, and is supplied with 
large ventilators. The latter are of especial importance after 
her reconstruction into a hospital ship. Major Torrey, Sur- 
geon U. S., formerly stationed at West Point, is in command 
of the ship, and had charge of the work of reconstruction in 



52 



making the necessary changes in adapting her for hospital use. 
Many important changes in the interior of the ship had to be 
made in transforming an ordinary passenger steamer into a 
hospital ship. The major has spent six anxious, trying weeks 
in accomplishing this. He availed himself of the valuable ser- 
vices of Naval Constructor Bowles. The work was done at the 
foot of Ninth street, New York, and '.vas watched with great 
interest by the public and the medical profession in that city 
and surrounding towns. Many of the stateroonas had to be 
removed to make space for five capacious wards. About 650 
men were employed night and day in pushing the work to com- 
pletion as rapidly as possible. American pluck and energy 
were well displayed in completing the herculean task in four 
weeks. The entire expense of reconstruction will reach nearly 
$150,000,60 that the ship costs the Government about $600,000. 
I doubt if any other equal sum for any other purpose will do 
so much for our army as this floating house for the disabled 
soldiers. 

The interior of the ship is so arranged that every nook and 
corner can be utilized to advantage. On the hurricane deck 
forward is the search-light on the pilot house, the pilot house, 
pilot's and ship officers rooms. Center and aft are canopied 
for convalescents, and are well supplied with long wooden 
benches and steamer chairs. Eight life boats and four rafts 
constitute the life saving, outfit. There are also two steam 
launches 28 feet in length with a speed of nine knots an hour. 
The upper saloon deck is intended for medical wards mainly. 
Ward No. 1 is forward and has 82 beds. The iron bedsteads are 
of special construction, securely fastened to the floor. The 
cots in use are iron framed double-deck beds of single width, 
with wire spring mattress and adjustable side fails. Cotton 
mattress, linen sheet, two blankets and two horsehair pillows 
constitute the bed proper. Each bed has a wire basket atta.ched 
for dressing material ana medicines. 

This ward is supplied with two toilet rooms, a stationary 
bath tub and sink in middle of ward, with adjustable canvas 
screen. Provision has also been made here for hot and cold 
water shower bath. The room is lighted by four reflectors 
with six incandescent burners to each, and a number of green 
shaded incandescent burners. Four electric fans will prove a 



53 



source of comfort during hot weather. The center of this floor 
is devoted to state rooms for the female nurses, mess room for 
ward No. 1, and a large pantry containing tableware and facil- 
ities for preparing special diet. Ward Xo. 2 aft end of the ship 
with a capacity of 61 beds is connected by a hatchway with 
ward No. 4 below. Bath, toilet rooms, electric lighting and 
fans same as in ward No. 1. Forward on lower saloon deck 
are the sailor's quarters, oflBces, sleeping apartments and mess 
room for the medical officers, medical library and a small 
ward of 28 beds, well lighted and ventilated. In the center of 
this deck is the kitchen and mess room for the hospital corps 
and male nurses. At the entrance of the gangway and in a 
corner of the large surgical ward with 74 beds is the operating 
room. This room is large enough for all practical purposes, 
and contains two operating tables, a high pressure steam ster- 
ilizer, reagent and dressing cases, stationary wash stand, two 
instrument cases, two formalin sterilizers and two electric fans. 
The floor is made of interlocking rubber tiles. The fourth ward 
is well lighted and ventilated. On one side of this ward are 
stationed a static and X-ray apparatus under the management 
of Dr. Gray. 

On the lower deck forward is the fireman's forecastle (27 
beds), an ice machine with a capacity of a ton and a half a day, 
a refrigerator and an apparatus for manufacturing carbonated 
water at the rate of 100 bottles an hour, a water condenser 
(sixty gallons an hour) and a sterilizer (carriage 4 feet, 6 inches 
by 8 feet, 6 inches, which can be used for the disinfection of 
large articles by, a, steam under ten pounds of pressure at 
240 F., h, formaldehyde, c, ammonia). In the center of this 
deck are the carpenter's and plumber's shop and a steam 
laundry of ample dimensions. Forward aft on this deck is 
ward No. 5 with forty beds, mess room and quarters for the 
hospital corps. A small laboratory for scientific _work has 
been fitted up with many of the modern facilities and has been 
placed in charge of Dr. Gray of the Army Medical Museum. 
If Santiago has not been taken by the time we arrive the ship 
will be anchored at the most convenient point near the shore 
and the transfer of patients will be made by the use of the two 
steam launches on board. Arrangements have been made for 
taking patients aboard by canvas basket, by hoisting boat, or 



54 



by stretcher up the stair gang, which for this purpose has been 
made much wider than usual. The ship is in charge of Capt. 
Frank Harding, First Officer C. W. Crocker, Second Oflacer 
Harksen, Engineer Charlton and a crew of sixty-eight men. 
Major Tomey is assisted by Major W. C. Gourgas and Major 
Bradley, both of the United States Army. Lieut. J. T. Crabbs, 
8th U. S. Cavalry, is quartermaster and commissary, and Rev. 
George Robinson, U. S. A., and Rev. Father J. N. Connolly of 
New York, are the chaplains. Thre are sixteen trained nurses 
on board, ten male and six female, and a detachment of twenty- 
nine hospital corps men. The names of the female nurses are : 
Miss Elise H. Lampe, Miss Louise Jones Block, Miss Amy 
B. Furguhasson, Miss Lucy Ashby Sharp, Miss Amanda J. 
Armistead, Miss Esther Voorhes Hasson. The following con- 
tract surgeons have been assigned to duty on the ship : Drs. 
Myers, Schultz, Tierney, Jr., Williamson, Hartlock and Met- 
calf. The ship carries a large supply which will meet the 
immediate demands of the suffering troops. Every one on 
board is anxious to reach the destination to lend a helping 
hand. The female nurses have utilized the time in preparing 
the wards for the reception of patients. If it were not for the 
blue ocean, the waves and the motion of the ship, it would be 
difficult to realize that we are not in a well-regulated, well- 
equipped hospital on terra firma instead of a floating hospital. 
Tomorrow (July 7) the doors of this great floating institution 
will be thrown open for the benefit of those who have become 
incapacitated for duty in the field, and there is a great proba- 
bility that every cot will be occupied in less than twenty-four 
hours after its arrival at the seat of action. The journey so 
far (July 6, 10 a.m., off San Salvador) has been a very pleasant 
and auspicious one. A stiff breeze from the south is fanning 
every room and cheering and invigorating its inmates. All is 
in readiness to fulfill the mission for which this messenger of 
mercy has been sent to the distant seat of war. Thousands of 
anxious hearts at home and in Cuba are following its course in 
thought and prayer and will be rejoiced when they know that 
its anchor has been dropped and its deck cleared for action. 



THE MEDICAL DEPARTMENT OF THE ARMY IN THE 
CUBAN CAMPAIGN. 

On Board the Hospital Ship "Relief," July 31, 1898. 
In an editorial of the Medical Record of July 30, suspicions 
are thrown out reflecting on the efficiency, foresight and proper 
management of the Medical Department of the Army during 
the Cuban Campaign. The remarks made by the editor are 
based, as he himself asserts, almost exclusively on a correspond- 
ence which appeared in a recent issue of the Sun, In com- 
menting on this article the editorial states : "If the report is 
true, and there seems to be no good reason for doubting it, the 
Army Medical Department appears in a very unenviable light. 
It is said that there was a total lack of everything necessary 
for the proper care of the stricken soldiers. Why this was so 
it is hard to explain, especially in view of the fact that the war 
department has constantly declared, in declining voluntary 
assistance from charitable organizations, that it was abund- 
antly able to cope with any possible emergency in the field, 
and yet this is the result." The correspondent of the Sun 
made bold in saying: "It was evident that the Medical 
Department of the Army had failed absolutely to send hospital 
supplies, or by this time they would have been landed. On 
the one hand it was pitiful. On the other, it was negligence 
that could have been the result only of incompetence." I am 
sure if the editor of the Medical Record had been better 
informed he would not have been so willing to lend his ear to a 
newspaper correspondent whose success nowadays consists 
largely in tinging facts with more or less imagination and sen- 
sationalism. The medical men inside and outside the army 
have little, if any, influence over the lay press, but the editor of 
a medical journal of such high standing with the medical pro- 
fession throughout the entire country as has been willingly 
accorded the Medical Record, should take the necessary pains 
to investigate more thoroughly the circumstances which dic- 
tated the editorial before casting any reflections whatsoever on 



56 



the chief of the medical department. Dr. George M. Stern- 
berg is no stranger to the medical profession and the American 
people. He occupies the exalted position of Surgeon- General 
of the United States Army, not by political preferment or 
gradual ascent by promotion, but by merit. President Cleve- 
land made a wise selection when he made the appointment. 
It was a selection that met with the heartiest approval on all 
sides. General Sternberg knows from long and actual experi- 
ence what it is to be a soldier in the field. He has been there. 
He served with distinction during the War of the Rebellion. 
He has followed the unruly and wily Indians over plains and 
mountains during many a campaign. He has investigated 
yellow fever at home and abroad, regardless of his own health 
and life. Since he has been placed in charge of the Medical 
Department of the Army he has been tireless in making many 
much-needed improvements. 

The Army Medical School is one of the many fruits of his 
labors. He has taken special interest and pride in promoting 
the intellectual and professional advancement of his young 
army surgeons, assigning them for temporary duty in large 
cities, where they could enjoy clinical instruction and labora- 
tory work. He has taken a deep and active interest in the 
organization and usefulness of the Association of Military 
Surgeons of the United States, and served most acceptably as 
president. Last year he was honored by the profession by 
election to the Presidency of the American Medical Associa- 
tion. The earnest devotion to his duties made it impossible 
for him, to his great regret, to attend the Denver meeting. 
The name of General Sternberg is often seen on the programs 
of scientific societies from the Atlantic to the Pacific and from 
Labrador to the Gulf. He crossed the Atlantic, last summer, 
to represent his Government at the International Congress, 
held in Moscow, Russia, and his work there added much to 
the luster of American medicine. The Surgeon- General, now 
so unjustly accused of incompetency, not only is accorded a 
well-deserved place in the front rank of the profession, but 
his administration shows executive talents which have served 
him well during the present campaign. He has shown good 
judgment in the selection of his advisers. Colonels Alden, 
Greenleaf and Smart, are all men of large experience and 



57 



admirable executive abilities, as all can testify who have been 
brought in contact with them. The charge of incompetence 
and ignorance certainly lacks foundation in the case of General 
Sternberg and his administration. Now, as to facts. The 
correspondent of the Sun who furnished all the material for 
the editorial referred to goes on to say : " The wounded were 
carried back from the fighting line on stretchers, and laid on 
the ground to wait until the surgeon^ -^^i^^d reach them, Many 




Brigadier-General George M. Sternberg, Surgeon-General of the Army. 

were soon beyond the need of surgical treatment. There were 
four divisions of the army, and each division was supposed to 
have its hospital ; but as a matter of fact there was but one, 
the division hospital of the Fifth Army Corps, under Major 
Wood. There were five surgeons, a hospital steward, and- 
twenty assistants, to care for the wounded— several hundred. 
They had a number of operating tables, a small supply of 



58 



medicines, but few bandages, and no food for sick or wounded 
men. It was comparatively easy to get supplies from the State 
of Texas ashore to the hospital here (Siboney), but there was 
no transportation to the front." In the opinion of the editor 
of the Medical Record and the correspondent of the Sun the 
Red Cross Association's work was the only redeeming feature, 
of the whole campaign, to judge from the language of the 
latter : " God knows what we should have done here without 
the help of the Red Cross — your ship, your surgeons, and 
your nurses ! and there is no other help for us at the front. 
Our wounded up there must have food, bandages, anything 
you can let us have in the line of hospital supplies." The edi- 
torial in the Medical Record brings matters to a focus in the 
closing extract : " It is right and proper that the Surgeon- 
General should resent any interference with his prerogatives, 
but he should not directly invite it by making possible such 
a condition of affairs as here described." This inference i& 
entirely unwarranted by facts as they existed during and after 
the battle of Santiago. 

The correspondent and editorial do not even mention the 
steamer Olivette we found July 7 anchored close to the shore 
before Siboney. This steamer, in command of Major Appel^ 
U. S. A., was used as a hospital ship. This ship was in place 
and ready to receive the wounded during the battle. The 
steamer, at the time mentioned, had on board 300 wounded, 
who received the best surgical attention and nursing. The 
next day the steamer left for the United States, the medical 
staff being reinforced by the addition of Acting Assistant- 
Surgeon Brown of Chicago from the Relief. General Stern- 
berg at an early date recognized the importance of hospital 
ships during this war. The Olivette was chartered for this 
special purpose, Tas well equipped and reached the seat of 
war in time. The hospital ship Relief, formerly the John 
Englis, under the supervision of its commander. Major 
Torrey, was transformed into an ideal floating hospital in less 
than six weeks and reached Siboney July 7, a day before the 
Olivette left for its home port. Do these things show either 
negligence or ignorance ? Do they not rather demonstrate 
foresight and an earnest endeavor to better care for the sick 
and wounded in a way creditable to our country and the chief 



59 



of the Medical Department? This question can safely be left for 
the wounded to answer. The Surgeon-General accepted the 
legitimate services of the Red Cross Association and had rea- 
son to expect aid from this source, should pressing emergen- 
cies present themselves. The medical officers, the wounded 
and the sick have every reason to be grateful to Miss Clara 
Barton, for what she did in furnishing ice, delicacies and 
medical supplies. The State of Texas did excellent work in 
aiding the Medical Department, but that is no reason why 
those connected with the Red Cross Association should claim 
all the credit and undertake to criticise a department of the 
government which has done all it possibly could in anticipating 
the requirements of a sudden emergency. It is a source of 
great regret that ihere should be any friction whatever 
between the Medical Department and the friends and sup- 
porters of the Red Cross Association. It must be clear to 
every unprejudiced mind that the treatment of the sick and 
wounded must remain under the direct care, control and man- 
agement of the Medical Department, and that the function of 
Red Cross is rather auxiliary to it than as an independent 
organization if the greatest amount of good is to be realized 
from it. The hospital ship Relief brought an immense amount 
of medical supplies, delicacies, cots, pillows and blankets. 
When we arrived at Siboney we knew our presence was much 
needed, and looked in vain for some one to inform us where and 
how to land. The precipitous and rocky nature of the shore 
and the great depth of the ocean made it unfavorable to secure 
anchorage for several days. A single lighter attended to the 
demands of numerous transport ships. I am sure no one 
could blame the Medical Department for the unavoidable 
delay in unloading the supplies. The little steam launches did 
what could be done in bringing to the shore what was most 
needed. Major Torrey worked night and day in supplying 
the requisitions made by the surgeons in the field and hospi- 
tals. There was no red tape here, all they had to do was to 
inform him what was wanted and it was delivered as soon as 
it could be brought to the shore. The lack of proper transpor- 
tation facilities from the landing to the front can not be 
charged to the Medical Department. It took more than a 
week of the hardest kind of work to land all of the supplies, 



60 



and, considering the limited facilities available, it is and 
always must be regarded as a source of satisfaction that it was 
made possible at all. The Relief brought 1000 cots and an 
ample supply of bankets, which reached the hospitals with as 
little delay as possible. 

Lieut. Crabbs of the 8th Cavalry, showed a creditable degree 
of ingenuity, energy and often of courage in landing the sup- 
plies. The complaint that the sick and wounded lacked medi- 
cines and dressing materials is true only to a certain extent. 
Some of the medicines were exhausted, owing to the unexpected 
enormous demand, but they were supplied as quickly as could 
be done under the existing circumstances. The writer had the 
privilege to operate in all of the hospitals and was always able 
to find the essential antiseptics and dressing materials required 
in military practice, and this was at a time when the supplies 
were at the lowest. There was no lack at any time of stimu- 
lants and anesthetics. There is no use in denying the fact 
that immediately after the battle the tentage and blanket sup- 
ply were inadequate, but these defects were corrected promptly. 
War always has had its hardships and discomforts ; it can not 
be prosecuted in parlor cars and clubhouses. Or soldiers ex- 
pected deprivations and unavoidable discomforts, but on the 
whole they were subjected to less actual suffering than they 
had reason to look for. To the credit of the medical officers it 
must be said they shared the inevitable hardships with the 
soldiers. They lived on the same food, drank the same water 
and made the moist ground their beds. The writer will always 
cherish the memory of the hardships incident to a campaign 
in a foreign country, a tropical climate and among a strange 
people. The Cuban campaign was planned and executed so 
quickly that some omissions and defects had to be expected. 
It is a source of gratification to know that the complaints 
made against the medical department have come from news- 
paper correspondents and camp followers more than from the 
soldiers themselves. Among the thousands of sick and wounded 
with whom I have been brought in contact during the Cuban 
campaign I have seldom heard a complaint ; on the contrary, 
I have heard nothing but words of praise for the hard-working, 
self-sacrificing medical officers and the department they repre- 
sent in the field. 



THE QUALIFICATIONS AND DUTIES OF 
THE MILITARY SURGEON. 



Nearly five months of continuous service with the 
army in the camp and field has afforded me an excel- 
lent opportunity to make a practical study of the 
above subject. This time was spent in Camp Tanner, 
Springfield, 111.; Camp George H. Thomas, Chicka- 
mauga, Ga., and the Cuban campaign, the time being 
about equally divided in the different places. The 
first four weeks were occupied in Camp Tanner, 
where I assisted in the capacity of Surgeon- General 
of the State in the organization of the State troops. 
This service brought me into closer contact with the 
National Guard of our State than at any time before. 
A physical and professional examination in which I 
took part brought out the shady as well as the sunny 
side of their qualifications. The result of my experi- 
ence here convinced me that the average National 
Guard surgeon is a faithful doctor, with more than 
average professional ability, but, with few exceptions, 
lacking the necessary military training in performing 
satisfactorily his administrative duties. This is a 
part of his education that has been sadly neglected 
in the past and should receive more attention in the 
future. Very few States make provision for physi- 
cal examination of the medical officers, consequently 
some of them have entered the service totally dis- 
qualified for participating in an active campaign. 
Two of the candidates for the volunteer service from 
the National Guard of Illinois were rejected on this 
ground. The four weeks' service at Camp George 
H. Thomas as chief surgeon of the Sixth Army 
Corps opened up a wide field for extended observa- 
tions in making comparisons between the work done 



62 

by the surgeons of the regular army and of the 
National Guard. The surgeons of the United States 
Army are all men of superior education, splefiidid 
physical development, and those who have been in 
the service for several years are well vejsed in the 
routine work of the Medical Department. However, 
in all matters pertaining to medicine and surgery 
the average National Gruard surgeon more than holds 
his own. This superiority of the National Guard 
surgeon over his colleague of the regular army is 
no reflection on the latter; it is the natural outcome 
of circumstances, which made such a difference inev- 
itable. The young army surgeon has to spend many 
years at small and often out-of-the-way posts, where the 
opportunities for clinical experience and intercourse 
with professional colleagues are necessarily limited. 
He naturally soon falls into the monotonous and 
routine work of the post life, with little or no induce- 
ments to continue his post-graduate, scientific and 
medical studies. When the time comes to pass an 
examination he wakes up from his lethargy suffi- 
ciently to go through the different compends to pre- 
pare himself for the coming ordeal. He breathes 
easy after he has reached the major's rank, as this 
promotion forever closes the door of the much- 
dreaded green room. From now on he is in the 
line of slow promotion without any extra exertions 
on his part. He receives his salary and looks confi- 
dently for assignments to posts where he can spend 
the balance of his life in ease and luxury. He has 
reached a time in life when he feels that he can avail 
himself of the work of his subordinates without 
interfering with his emoluments or his position in 
social and military life. He is conscious of the fact 
that he has reached a rank and a station in life where 
it is proper for him to look to his assistants to do the 
drudgery which he had become accustomed to in the 
past, and begin to enjoy the life before him. It is 
different with the military surgeon taken from civil 
life. He emerges from the turmoils of family prac- 



63 

tice. From the day of his graduation he has tasted 
the bitter fruit of active competition. His work has 
been watched with an envious eye and subjected to 
sharp criticism by his neighboring colleagues, old and 
young. He felt from the very beginning of his pro- 
fessional career that success depended upon his own 
exertions. The average American practitioner is a 
hustler. He is willing to work night and day to gain 
a lucrative practice and the social position which goes 
with it. With few exceptions he knows that what he 
has learned in college is but the entering wedge to a 
comprehensive knowledge of the practice of medicine 
and surgery. He knows that our profession has 
become a progressive one. His college education 
tells him what is new today will be old tomorrow. 
He looks with pity on his colleagues, advanced in 
years, whose language and practice convince him that 
they have fallen into a dangerous rut. He reads the 
numerous medical journals, the great avenues of 
recent medical literature. He spends his scanty 
income in purchasing new books and instruments for 
scientific investigations. All requisitions are made on 
himself and are honored only by writing bis own 
checks. He joins medical societies, large and small, 
and attends their meetings regularly. He listens 
intently to the reading of papers and discussions to 
increase his store of knowledge and returns to his 
limited field of action better prepared to battle against 
disease. He mingles freely with the members of his 
profession, always ready to absorb and digest new 
ideas. He makes frequent pilgrimages to his alma 
mater or some post-graduate school to familiarize 
himself with the most recent advances in medicine and 
surgery. Social life has no attractions for him ; he has 
entered the profession for the sole purpose of becom- 
ing an infiuential and successful practitioner. This 
is the kind of material our National Guard surgeon is 
made of. Xo wonder he outweighs the professional 
military surgeon in practical knowledge required in 
the treatment of injuries and disease. 



64 

Th-e exacting and often onerous duties of the mili- 
tary surgeon in times of war require special qualifica- 
tions to prepare and fit him for his work. He is not 
only expected to be well versed in theoretical and 
practical knowledge of everything pertaining to the 
practice of medicine and surgery, but he must be 
endowed with qualities both of mind and body upon 
which he can rely when engaged under the most try- 
ing circumstances. In field work he has often to 
perform the most difficult tasks with very limited 
resources. In such instances good common sense 
and deliberate action go much further in accomplish- 
ing what is desired than the finest scholarship and 
the most profound logical reasoning. The man who 
can in a few moments extemporize a well-fitting splint 
out of the simplest materials and perform with the 
contents of an ordinary pocket case the most difficult 
operation will do vastly better work on the battlefield 
than most professors of surgery and the most brilliant 
operators in civil practice. The surgeon who under- 
stands the principles and practice of good cooking is 
of more service to the troops than the one who can 
repeat, word for word, the contents of the most 
exhaustive treatise on materia medica and therapeu- 
tics. The medical officer with a full knowledge of 
hygiene and sanitation and endowed with the faculty 
of making a rational, practical use of it is preferable 
to the most expert clinician, as in military practice it 
is more important to prevent than to treat disease, no 
matter how successfully and scientifically the latter 
may be conducted. The alharound medical officer 
must be a good mechanic; he should know how to use 
the carpenter's and blacksmith's tools, how to row and 
sail a boat, how to make a raft and occasionally he 
will have reason to be thankful if he has learned how 
to pack a mule and drive an ambulance team. His 
miscellaneous knowledge of matters and things en- 
tirely outside of his legitimate province will be con- 
stantly drawn upon from different sources and the 
more he knows and is willing to impart the more he 



65 



will be useful and popular. The man who enters the 
medical department of the army under an impression 
that he is only expected to treat wounds, set broken 
bones and prescribe for the ordinary camp ailments 
makes a serious mistake and will be surely a disap- 
pointment both to himself and to those he is expected 
to serve. 

Physical condition. — The ideal military surgeon in 
possession of the necessary mental and physical qual- 




Transfer of wounded to the hospital ship Relief at Arroya. 

ities to make him so is seldom seen. The most active 
brains are often found in a frail body. I have often 
seen in civil life surgeons of great reputation strug- 
gling with disease or its effects, or the victims of 
some congenital or acquired defects, who were won- 
ders in the operating amphitheatre in spite of such 
disability. I have seen more than once the saddest 
of all spectacles in professional life — a surgeon, himself 
the subject of an incurable disease, muster into service 
every particle of his reserve strength to perform a 



66 

critical operation with a view of saving the life of 
another. Achievements of this kind are possible in 
private practice but are entirely out of the question 
in military service. The physical condition of the 
military surgeon must be as nearly perfect as possible. 
A physical examination as thorough and as painstak- 
ing as in the case of a private can only decide upon 
the necessary physical qualifications of candidates for 
commission in the medical service. For good reasons 
this rule is followed in the selection of medical offi- 
cers for the regular army and there is no ground why 
the same requirement should not be exacted in the 
National Guard. During my service at Ohiokamauga 
and in the Cuban campaign, I saw more than one 
volunteer surgeon who ought to have been excluded 
from the service for physical disability. During a 
campaign the loss of a single medical officer may 
prove a great disaster. Of all commissioned officers 
the surgeon is the most indispensable. The vacant 
place of a line officer can be filled at a moment's 
notice without any serious loss to the service; not so 
with the surgeon. His position is one requiring 
special training and one that can not be filled without 
crippling the medical service at some other point. For 
this, if for no other reason, the medical officer must 
be in sound health and able to cope successfully with 
the hardships of a campaign. In battle, and during 
the prevalence of an endemic or epidemic disease, the 
medical officer is the one above all others whose 
strength and endurance are taxed to their utmost 
extent. His services are required by day and by 
night. He has no rest, and unless in possession of 
an iron constitution, his strength fails him and he 
becomes, if not a fit subject for the hospital, at least 
a physical wreck, who, if he persists in continuing his 
work, will often do more harm than good. A number 
of such instances came to my personal notice during 
the Cuban campaign. A medical officer should not 
only be in full possession of health and all that this 
implies, but he should have been in training to 



67 



endure hardships of all kinds from early childhood. 
He need not necessarily be an athlete, but he should 
be able to walk twenty miles a day or ride forty with- 
out fatigue and then be ready to do a night's work 
should an emergency demand it. The dancing halls 
and club houses are poor training schools for a suc- 
cessful military career. The labor and hardships 
encountered in hunting are best calculated to prepare 
the body for a life of great activity and privation. 




The Spanish military hospital iu Ponce, Porto Rico. 

Frugal living will not only prove conducive to the 
maintenance of health but will be the best means of 
initiating the surgeon to the uncertainties of the com- 
missary department when on the march or in the 
field. 

Let every one who chooses the military career dis- 
pense with unnecessary clothing and luxuries during 
early life in order to accustom and adapt himself for 
his life work, which in time of war will bring the 
inevitable amount of viscissitudes and even suffering. 



68 

The medical officer must be a good horseman, which 
here not only implies a good rider, but a knowledge 
of the usual ailments of horses, the treatment, feed- 
ing and care of the animals. To sum up, the military 
surgeon must be a man of vigor, made so by birth and 
training, with as few requirements in his habits of 
living as possible, in order that he may resist to the 
highest degree the influences of climate and disease 
and prepare himself for the hardships and privations 
incident to active warfare. 

Mental qualifications. — A proper and adequate 
preliminary education is exacted of every surgeon in 
the regular army; without it he is not permitted to 
pass the medical examination. Statistics show that 
a large percentage of the candidates are dropped at 
this stage of the examination. This is a reflection 
on the system of medical education which continues 
to prevail in our country. About the only evidence 
of. proficiency the National Guard surgeon in most of 
our States is required to show is his diploma. It 
makes but little diflference when the diploma was 
obtained. Evidences of a satisfactory preliminary 
education are not required. In consequence of such 
an easy entrance into the medical service of our State 
troops, many of the men who receive commissions ' 
are illiterate. By hard post-graduate work they often 
become good physicians, but they seldom if ever 
make up for the early defects of their education, 
which seriously interfere with a successful military 
career. Is it to be wondered at that when such short- 
comings are discovered by their colleagues and officers 
of the line, they do not command the respect their 
commissions, should entitle them to? The reports 
made out by such men speak for themselves, and 
appear as black stains upon the department they rep- 
resent. The elevation of the standard of medical 
education by most of the medical schools throughout 
the country will gradually wipe out this blemish, but 
it will take many years before all of the diplomas can 
be accepted as sufficient proof that their possessors 



69 



ara entitled to recognition by the medical department 
of the different States. Let us hope that a speedy 
and radical reform may be instituted in the different 
States which will accomplish the desired object, and 
which will make the commission of a medical officer 
of greater import in showing a higher degree of pre- 
liminary and professional proficiency than the diploma 
of any of our medical colleges. This is a desideratum 
for the realization of which every one interested in 




Ambulance train on the way to the hospital ship Belief in the harbor 
of Ponce. 

the success and usefulness of the national guard 
should willingly use his influence. Fortunately, there 
are no specialties in military practice. The medical 
education of a military surgeon must be of the most 
liberal and broadest kind. His practice is so varied 
that he may have to be physician, surgeon, oculist, 
aurist, etc., the same day. The sphere of the regular 
army surgeon serving at a post includes in addition 
obstetrics, gynecology and diseases of children. Every 



70 

military surgeon must be an expert in physical diag- 
nosis and examination of the eye and ear. He must 
know something about dentistry, he must know how 
to extract teeth and how to put in a temporary filling 
in a carious tooth that can be saved. He must be 
familiar with neurology, the use and application of 
electricity as a diagnostic and therapeutic resource. 
In camp and field he is limited to his own resources 
in the diagnosis and treatment of all kinds of injuries 
and diseases. He must therefore be well equipped 
with a thorough knowledge of everything pertaining 
to surgery and medicine, and is often called upon to 
represent the different specialties. No amount of 
preliminary and professional education will make the 
military surgeon an efficient officer unless he is pos- 
sessed of an inborn aptitude for the profession. He 
must be able to apply and make use of his knowledge. 
Many men of great learning never become successful 
practitioners. Their store of knowledge fails them 
when they come to apply it. The military surgeon 
in camp and field must be a man of quick perception. 
He must be able to recognize malingering as well as 
disease. In an emergency he must be in readiness to 
act intelligently at a moment's notice. Hesitation is 
dangerous both to the patient and the reputation and 
good standing of the surgeon. Indecision creates 
mistrust, procrastination disaster. Quick decision 
and prompt action are the essential prerequisites of 
successful emergency work. Successful action, how- 
ever, must be preceded by thoughtful, systematic 
preparation. The most successful surgeon is the one 
who adopts and follows the watchword, semper para- 
tits. He should never be caught napping. Careful 
preparation makes prompt action possible. The suc- 
cessful surgeon makes his plans ahead and supplies 
himself with the necessary outfit, medicine, dressing 
materials and instruments before the emergency arises, 
and when it does so he is fully prepared to meet it. 
A lack of forethought and systematic preparation 
accounts for many shortcomings of medical officers 



71 



in the field and camp, with the necessary evil conse- 
quences for those entrusted to their care. 

Military spirit. — Any one who enters the medical 
service of the army as a life avocation will be disap- 
pointed unless he does so imbued with a proper mili- 
tary spirit. The military surgeon must be a military 
man and an integral part of the army, if he wants to 
do justice to his calling and the department he repre- 
sents. I fear it is a lack of the proper military spirit 




Litter work in the court of the Spanish military hospital in Ponce. 

in some of the medical officers in the regular army 
that is responsible for a well recognizable cleft 
between them and the officers of the line and field. 
If this is true in the regular army, it is only too obvi- 
ous in the National Guard. The rank of the medical 
officers and their standing in military and social cir- 
cles suffer when they are regarded and treated as an 
ordinary doctor. The West Point graduate, educated 
at the expense of the government, too often forgets 
that it takes more hard work and a longer time to 



72 

make a good doctor than an officer. The officers of 
the National Guard, holding commission by the grace 
of their governor, do not realize sufficiently that their 
military surgeons have spent a small fortune and five 
years in acquiring a knowledge of their profession. 
They seem to forget, or at any rate often ignore, that 
when they go into camp or in the field they do so at 
a great personal and pecuniary sacrifice. Their ab- 
sence from home, even for a short time, may cause a 
break in their practice difficult to repair. The medi- 
cal officer is entitled to recognition as a military man, 
and if this is not accorded to him voluntarily, he 
must resort to measures that will enforce it. The 
lack of military dignity on part of the medical staff 
is due largely to a lack of the proper military spirit 
in the members which compose it, and to too great a 
familiarity between the surgeons and the officers and 
men. The correction of these evils can not be under- 
taken too soon, and when accomplished will add much 
to the dignity, influence and efficiency of the medical 
department of the army and State troops. 

The medical officer who has enjoyed the advantages 
of an early military training in a military academy 
or the national guard, is the one best qualified to 
enforce military rules and assert the dignity of his 
position. 

Punctuality. — The busiest men have always the 
most time to perform a duty or to meet an engage- 
ment at the appointed time. This rule holds good in 
all walks of life. The drones are always behind. In 
military life punctuality means everything and from 
this exaction the medical officer should never be 
excluded except for special and well founded reasons. 
In the regular army there is a way of disciplining the 
medical as well as other officers in coming to time in 
the performance of definite duties and in making out 
the reports. My long experience in the ^National 
Guard service has taught me, occasionally in a pain- 
ful way, that the surgeons are often entirely oblivious 
to the matter of time, especially in the matter of 



73 

making out and transmitting the regimental reports. 
It is the men who put off for tomorrow what should 
be done today, and who meet their engagements at 
one o'clock or thereafter instead of twelve, that ren- 
der the life of their superior officers one of misery 
and full of disappointments. The men that accom- 
plish the most are always ready and on time. The 
medical officers must be made to understand that a 
due regard for punctuality in performing their duties, 




i 






Court of the Spanish military hospital in Ponce. 

in meeting appointments and in mapping out and 
forwarding reports is one of the most essential feat- 
ures of a successful military career. 

Courage. — It is still the general belief that, in 
times of war the military surgeon is exposed to less 
danger than the soldiers and officers in command. 
That this is not so is shown by the statistics of all 
wars. Although the position of the military surgeon 
is behind the fighting line, he is usually near enough 



74 

to the enemy when serving in the front to be 
reached by stray bullets and bursting shells. The 
number of surgeons killed and wounded in the per- 
formance of their duty in rendering first aid is by no 
means small in any war of magnitude. In active war- 
fare, however, the greatest danger to the surgeons is 
to be found in their constant exposure to contagious 
and infectious diseases, which follow large armies in 
all climates and during all seasons of the year. To 
enter a yellow fever camp, to my mind, calls for more 
courage than to lead and command the troops in the 
battlefield. Disease always claims more victims than 
bullets, and this is especially true of the present war 
with Spain. The nation worships the heroism of 
those who fell before Santiago, but much less is said 
of the vastly greater number stricken down by dis- 
ease, and who have lost their lives from disease, often 
after prolonged and intense suflPering. To the credit 
of the medical officers of this and other wars it must 
be said that they showed no fear, either in facing the 
enemy or what is vastly worse — disease. When yel- 
low fever made its appearance among the troops 
around Santiago, every man remained at his post and 
faced the danger without flinching. Men from the 
North who had never seen the disease accepted the 
detail for duty in the fever hospitals without a word 
of complaint. The medical officer must be endowed 
with more than ordinary courage to face the many 
dangers that surround him on all sides during every 
campaign. Patriotism begets heroism and I make a 
well-founded claim for both for the medical profes- 
sion represented in the army. 

Personal hahits. — The old adage that *'It is easier 
to preach than to practice," is a familiar one and 
should be made to apply with the same force to doc- 
tors as preachers. The first and most important duty 
of the military surgeon is to prevent disease. This 
can often be done more efifectively by example than 
by precept. The military surgeon must guard the 
camp against disease. He is looked upon and must 



75 

be regarded by those under his care as the one above 
all others who can give them advice in matters per- 
taining to their health. He is expected to do this by 
example as well as precept. He must become a per- 
manent object lesson in inculcating the importance 
of cleanliness in person and in dress. His tent 
should be the cleanest and most orderly in camp. 
Temperance in eating and drinking can be taught 
more successfully by action than by words. A mili- 




Transfer of patients to the lifeboat in the harbor of Ponce. 

tary surgeon under the influence of liquor will do 
more harm in encouraging the vice of intemperance 
than can be undone by weeks of lecturing. Profan- 
ity is prevalent in every camp and while it is not the 
duty of the surgeon to supplant the chaplain in sup- 
pressing it. it should receive no encouragement by 
his example. In his conduct toward the men the 
surgeon should be firm and dignified, yet kind and 
sympathetic, especially to those in need of his pro- 



76 

fessional services. An impetuous nature and an irri- 
table temper create a rebellious spirit, which it is 
difficult to control by the most energetic measures. 
Proper questions should be answered willingly and 
with sufficient clearness and adequate length to fur- 
nish the desired information, and not gruffly and 
snappishly, as is occasionally done without any 
reason or provocation. Overwork and a disordered 
digestion are poor excuses for treating a subordinate 
in an undignified, ungentlemanly manner. The mil- 
itary surgeon must be known in camp as a gentleman, 
not only by the officers but by every man under his 
charge, if he expects to be respected and to do justice 
to his high calling and responsible position. 

The military surgeon in war. — The true qualities 
of the military surgeon are crystallized and best 
known during an active campaign. It is in war that 
his ready resources will come to the surface and will 
be subjected to the severest tests. It is in battle and 
during the prevalence of devastating diseases that his 
moral courage and physical endurance will be most 
severely tried. It is under such circumstances that the 
troops will look to him most confidently as their protec- 
tor and nearest and dearest friend. It is not in peace 
but in war that the bond of true comradeship becomes 
tighter and tighter between him and the officers and 
men. It is on the march, in camp, and on the battle- 
field that the important function of the military sur- 
geon receives the recognition to which it is entitled. 
It is the wounded and the sick in a strange land that 
look to him for help and restoration to health. It is 
the surgeon who so often receives the last message of 
the dying. 

The first and most important duty of the military 
surgeon during active warfare is to prevent disease 
and unnecessary suffering by giving early advice and 
resorting to timely precautions. The location of 
camps, policing of the same, the water-supply, food 
and clothing are subjects which must receive his early 
and earnest attention. In this work he should receive 



77 

the hearty co-operation of the oflScers in command 
and if this is not the case he has the moral and mili- 
tary authority to demand it. It was not the medical 
department, but the arrogance or stupidity of the com- 
manding general of the invading army that is respon- 
sible for the extensive outbreak of yellow fever during 
the Cuban campaign. This experience is sufficient to 
teach commanding generals that it is unsafe in the 
future to follow such an example, as an imprudence of 
this kind, giving rise to inexcusable slaughter and in- 
describable suffering, will meet with universal indig- 
nation. The military surgeon is in reality the family 
physician of the men placed under his charge. He 
attends to the little ailments with the same care as 
though he had been sent for by a wealthy family and 
expected a handsome fee. To be successful in the 
treatment of disease he resorts to the simplest medi- 
cation. Complicated prescriptions are dangerous and 
absolutely out of question in military practice. The 
tablets containing drugs in the most concentrated form 
are a great blessing to field practice and should be 
relied upon almost exclusively in the treatment of dis- 
ease. The remedies needed are few, and if well 
chosen and applied will answer all indications. A 
liberal supply of quinin, opium, calomel, strychnia, 
camphor, iron, arsenic, bicarbonate of soda and bro- 
mid of potassium will leave but little to be desired. 
Turpentine, castor oil, alcohol and the anesthetics are 
about the only fluid medicines the military surgeon 
has any use for. The breakage and waste in dispens- 
ing medicines in bottles are inexcusable in modern 
field work. Fancy drugs and preparations should not 
be tolerated. In the practice of surgery the military 
surgeon who wishes to attain the maximum success 
must be conservative. Strict asepsis and conserva- 
tism are the two things which are destined to make 
miltary surgery successful. Every surgeon must have 
special training in emergency work. He must be 
perfectly familiar with the indications and technique 
of every operation which may become necessary in 



78 

the field. He seldom will have an opportunity to cut 
for stone, extract a cataract, remove an ovarian tumor 
or operate for other benign and malignant growths, 
but he must know how to treat a compound fracture 
in the most modern and approved manner; he must 
be skillful in the treatment of wounds of all kinds, and 
he must be a master in performing an amputation and 
in ligating arteries in any part of the body. He must 
learn to perform all emergency operations with the 
simplest facilities and fewest instruments possible, in 
order to adapt himself in time to the exigencies of 
war. The surgeon who can extemporize an operating 
table in the field and who can secure asepsis with the 
use of the camp kettle, soft soap and carbolic acid or 
sublimate and who can perform the most difl&cult oper- 
ations with the simplest and fewest instruments, with 
little or no assistance, is the one who will accomplish 
the most and who will obtain the best results in the 
field. 

Ponce, Porto Rico, Aug. 8, 1898. 



THE INVASION OF PORTO RICO FROM A 
MEDICAID STANDPOINT. 



The occupation of Cuba and the Philippine Islands 
hy our conquering navy and army in such rapid suc- 
cession seemed to increase the desire of conquest and 
opportunities to test the strength of our arms. With 
the destruction of the weak navy of our enemy there 
was nothing in the way of sending troops to any of 
the many Spanish possessions. The fall of the heroic 
Oervera and his faithful little band, off the harbor of 
Santiago, before the murderous fire of our well- 
equipped fleet cleared the pathways of the ocean of 
further sources of danger. It was but natural that 
the beautiful island of Porto Rico, one of Spain's 
most valuable possessions, should have been selected 
by the military authorities as the next objective point 
for contention. Repeated attacks by our navy on its 
best stronghold, San Juan, had failed to bring about 
surrender and to gain a foothold on Porto Rican soil. 
So far the navy had taken the lead in bringing Spain 
to terms and the army was anxious to do its share in 
wresting from its greedy grasp another enslaved peo- 
ple. Major-General Miles, who conducted the inva- 
sion in person, decided to march upon San Juan from 
several directions, and, after uniting the forces, attack 
the city jointly. The experience gained in Cuba had 
taught us an important lesson in conducting the 
Porto Rican campaign. General Miles laid his plans 
wisely and with special reference to gain the desired 
object with as little suffering and loss of life as possi- 
ble. Every movement in this campaign was made 
with a due regard for the welfare and success of our 
troops rather than a desire for personal gain and 



80 

aggrandizement, which characterized the Cuban cam- 
paign, as every one knows. He was well aware of 
the depressing effects of the tropical climate on the 
unseasoned troops and of the necessity of resorting to 
timely and efficient precautions in preventing disease. 
From experience and personal observations, he recog- 
nized the fact that the unavoidable privations inci- 
dent to warfare are multiplied many times when the 
seat of war is a strange and remote country present- 
ing a climate and environments unaccustomed to by 
the invading force. His actions were clean-cut 
admissions that he was in need of a medical adviser 
and that they were influenced by the frequent con- 
sultations held with his chief surgeon. The war in 
Porto Rico was conducted upon the most humane 
principles, and although no great battles were fought, 
victory upon victory followed the footsteps of our 
army and in less than three weeks our flag floated 
over three of the largest cities of the island. Our 
troops love and respect their leader and have followed 
him without fear and grumbling under the scorching 
sun, full of confidence and trust. The news that 
peace had been declared reached the headquarters at 
Ponce, August 14, and the troops are now resting on 
their arms awaiting the final adjustment of the terms 
of peace. Eager to fight, yet every soldier in the field 
received this message of peace with joy and enthusi- 
asm, fully satisfied that the army had done justice to 
the fiag and country it represents. Col. Charles R. 
Grreenleaf, chief surgeon of the army in the field, 
accompanied Greneral Miles on his trip from Guan- 
tanamo to Porto Rico, and has been with the army 
ever since. He was long enough in Cuba to gain a 
full insight into the horrors created by infectious dis- 
eases, which so constantly follow large armies, espe- 
cially in a war of invasion. He was amazed when he 
saw to what extent yellow fever had broken out in the 
few weeks the troops had been in Cuba. There was 
no difficulty in tracing the disease to a total lack of 
precaution on the part of the general in command. 



81 




General Nelson A. Miles, in command of the Army in Porto Rico. 

By courtesy of " McClure's Magazine." Copyrighted 1898 by 

S. S. McClure Co. 



82 

Col. Greenleaf had given his directions a-nd advice 
before the army left Tampa, but they were not heeded. 
Owing to want of co-operation on part of Greneral 
Shafter, the medical officers found themselves power- 
less in preventing and combating the dreaded disease. 
Col. Grreenleaf's prompt and energetic action on his 
arrival in Cuba did much in repressing this disease, 
but it was too late too guard against a general out- 
break. The many recent graves in Cuba containing 
the remains of the victims of this disease are the best 
proof of what will happen when the leader of an army 
ignores the health and comfort of his men. In plan- 
ning the Porto Rican invasion, General Miles availed 
himself of the invaluable services of his chief sur- 
geon. The expedition was well supplied with medi- 
cines, hospital stores and medical officers to meet all 
possible emergencies. The result has been that the 
army has been so far singularly exempt from disease, 
with the exception of typhoid fever and the effects of 
heat, both beyond the control of the medical officers. 
Since his arrival in Ponce, Col. Greenleaf has been 
the busiest man in the army. He has not been con- 
tent in simply issuing his orders from headquarters, 
but he has attended in person to the execution of 
every detail. He has visited the camps and the hos- 
pitals and exercised personal oversight over the dis- 
tribution of hospital supplies, instruments and medi- 
cines. Anxious to serve the sick and wounded, 
impatient when face to face with a slow, hesitating 
subordinate, he has more than once performed tem- 
porarily the duties of an ordinary hospital steward, 
to furnish a much-needed object-lesson. His work 
will justify the confidence reposed in him when he 
was appointed to the high and responsible position he 
holds during this war. 

FIRST SKIRMISH. 

General Miles landed with his expedition, which in- 
eluded a number of war vessels, at Guanica, Monday, 
July 25. The harbor was entered by the now famous 



83 




Col. Charles R. Greenleaf, Chief Surgeon of the Army in the Field. 



84 

little gunboat Gloucester, under the command of 
Lieut.- Commander Wainwright. A landing was 
effected by thirty sailors, the Spanish flag was hauled 
down, and the stars and stripes raised amid the cheers 
of the sailors, who knew well that what they had just 
witnessed meant liberty and freedom for the down- 
trodden people of the island of which they had just 
taken possession. 

The planting of the flag and the deafening cheers 
which re-echoed from the hills of the liberated island 
were followed by a volley from the hidden enemy, 
which was promptly responded to by the guns of the 
Gloucester and a Colt rapid fire gun, which had been 
taken ashore. The Spaniards fled in confusion and 
sought shelter among the adjacent hills leaving four 
killed on the field, while our soldiers escaped without 
a scratch. The turn of the infantry came soon after 
landing, in the form of a lively skirmish, in which we 
lost one killed and fifteen wounded, of whom one died 
a day or two later. Most of the injuries were flesh 
wounds, which healed in a remarkably short time. A 
very interesting incident occurred during this skir- 
mish. The day was hot, and our troops had to ascend 
a steep hill, from the crest of which the Spaniards 
defended themselves. One of the volunteer soldiers, 
outrunning his comrades advanced far ahead of his 
line and when he nearly had reached the Spanish posi- 
tion was overcome by heat. He fell in a semi-con- 
scious state. A Spanish doctor rushed to his aid with 
a stretcher and two hospital corps men, administered 
the necessary restoratives and had him conveyed at 
once within our line. This one act alone goes to show 
that the Spaniards have often been unjustly accused 
of being cruel and inhuman. This certainly has not 
been the case during the present war. From my own 
observations I am sure that they have respected the 
Red Cross. In fact, the Red Cross people of Porto 
Rico, composed largely of Spaniards, have shown 
the greatest activity and interest in their humane 
work during the entire campaign. If anything, they 



85 

have rather been overzealous, judging from the num- 
ber of insignia displayed and worn. It was a com- 
mon thing to see men wear a white cap with an im- 
mense red cross on top, another one in front, besides 
the brassard. 

Ponce was taken and occupied without any resist- 
ance whatever. The citizens received our soldiers 
with enthusiasm and manifestations of joy. General 
Miles was hailed as a long-looked-for friend rather 
than a conqueror. The next engagement occurred 



1 












«^J 












'"1 












i 




^/^''X.l 


i 


1; 




ft^_ 


W^^t 


1 


■A 




'""% 



Fever patients in the court of the Spanish military hospital. 

between Arroya and Guayama, between a small 
Spanish force in ambush and General Haines' brigade, 
and resulted in eleven wounded on our side. The only 
death following this skirmish was a soldier of the 
Third Illinois Infantry who was shot accidentally by 
an unknown man of the Fourth Pennsylvania regi- 
ment. The bullet caused an extensive non-penetrat- 
ing injury of the chest, from the effects of which he 
died the next day. Such accidents have occurred too 



86 

often during the present war, and to prevent repetition 
in the future this matter should be investigated, as 
was done in this instance, by the proper authorities. 
Among the injured was a man who was shot through 
the pelvis and another one the subject of a gunshot 
wound of the elbow joint, both of them doing well 
four days later when I examined the wounded in the 
brigade hospital at Guayama. The third skirmish 
took place between the advance column of General 
Wilson's division, on the march to San Juan, and a 
small Spanish force intrenched on the summit of a 
high and steep hill. Lieut. Haines, the son of Gen- 
eral Haines, was the only one who was brought on 
board the Relief August 4. One of the wounded was 
operated on by Dr. Parkhill in an ambulance. The ab- 
domen was torn open by a fragment of a shell, the 
intestines protruded and a resection had to be made 
of a loop for a tearing injury. It was reported that 
the patient rallied well from the immediate effects of 
the operation and that hopes were entertained of his 
recovery. Another engagement took place between 
the troops under command of General Schwan, on 
their way from Ponce to Mayaguez, and about 1000 
Spaniards ambushed four miles from the latter city. 
This fight resulted in two killed and eighteen wounded 
on our side. All of the wounded were brought on 
board the hospital ship Reliefs which called at May- 
aguez on her way to New York, August 15. Such is 
a brief account of the casualties sustained by our 
army during the Porto Rican campaign. The expe- 
rience here coincided with that gained in Cuba, to 
the effect of confirming the humane nature of the 
modern weapon. The proportion of killed to wounded 
is even smaller than in the Cuban war, as well as the 
number of seriously injured. Thanks to more elab- 
orate preparations for the campaign, the wounded 
received prompt and efficient attention. The suffer- 
ing of the well, sick, and wounded can not be com- 
pared with what I saw in Cuba. War is a great edu- 
cator, and should we again be called upon to invade a 



87 



foreign country, we shall profit by the experience of 
the past. 

TYPHOID FEVER IX PORTO RICO. 

The native doctors in Ponce, Porto Rico, gave us 
the assurance that not a single case of yellow fever 
had been seen in that city for the last three years. 
We were informed that in San Juan isolated cases 
occur from time to time. Malaria is present in all of 
the valleys, more especially in and around Ponce. 




Fever patients in the court of tlie Spanish military hospital. 

The large, pendulous abdomen, and the pale faces of 
the many little naked children in city and country, 
are the best witnesses in showing the prevalence of 
malarial intoxication. 

Typhoid fever is endemic in certain localities, but 
at present Ponce is almost free from this disease. 
Having seen the destruction of life and the indescrib- 
able suffering caused by yellow fever in Cuba, Col. 
Greenleaf naturally turned his attention toward pro- 



88 

tecting our troops in Porto Rico against this scourge. 
The proximity of Porto JRico to Cuba, the many pos- 
sible sources of infection, made such a course impera- 
tive. That this fear was not unfounded, and that the 
Chief Surgeon recognized the danger and made use 
of timely precautions are but shown by the contents 
of a letter addressed to the Adjutant- General, Head- 
quarters of the Army, and Circular No. 1 issued be- 
fore the army sailed from Guantanamo to Porto Eico, 
and a copy of the Quarantine Regulations formulated 
at the same time. 

Headquarters op the Army, 
On board U.S.S. "Yale," en route to Porto Rico, 

July 23, 1898. 
To the Adjutant-General^ Headquarters of the Army, 

Sir : — I have the honor to submit the following recommenda- 
tions for preventing as far as possible the introduction of yellow 
fever into the command now about to land on the island of 
Porto Rico : 

The assignment of an officer of rank, to be placed in com- 
mand of the base of supplies, with authority to indicate the 
sites to be occupied by the various supply depots and the hos- 
pital, and to enforce the regulations governing the health of 
the attaches of these departments and the persons who may 
visit them on business. 

The assignment of a sanitary inspector whose duty it shall 
be to examine all vessels and persons arriving at our base from 
seaward ports, and to prepare sanitary regulations for the Gov- 
ernment of all transportation and persons arriving and depart- 
ing from the station by land. This officer should have author- 
ity to quarantine all suspicious persons and means of transpor- 
tation, and to disinfect their belongings, either by fire or such 
other means as may be deemed necessary. 

All persons connected with the Army are forbidden to enter 
any building whatever on the island without express authority 
from these headquarters, and all buildings in rural districts 
that may be suspected of harboring the germs of disease should 
be destroyed by fire or otherwise thoroughly disinfected. 

As woven goods, particularly those of woolen fabric, are spe- 
cial carriers of disease, the purchase or acceptance of articles 
of this kind from stores or inhabitants of the island is strictly 
forbidden. Any such property found within the lines will be 
at once destroyed and the holder subjected to punishment. 

That commanders of regiments be instructed to prepare their 
camping grounds with great care and maintain a rigid police in 
them ; under no circumstances shall they camp on ground that 



89 

has previously been occupied either by troops or by collective 
bodies of the inhabitants. 

That medical officers be required to make frequent inspec- 
tions of the commands to which they belong, and that any sus- 
picious case of fever be immediately isolated and the fact of 
its occurrence reported to these headquarters. 

Canteens should be filled daily with tea or coffee, and these 
beverages used habitually instead of water, unless that has 
been previously boiled. Very Respectfully, 

Chas. R. Greenleaf, Colonel, 
Asst, Surg-Genl. U.S.A., Chief Surg. Army in the Field. 




Ward in the Spanish military hospital. 

Headquarters oe the Army, 
Office of the Chief Surgeon, on board U.S.S. "Yale," 

EN route to Porto Rico. 
Circuktr No. 1. July 24, 1898. 

1. Medical officers will, upon receipt of this circular, report 
to the Chief Surgeon of the Army the number of medical offi- 
cers, hospital stewards, acting hospital stewards and privates 
of the Hospital Corps on duty with their command. Also the 
number of ambulances, litters and tents, and if medical sup- 
plies are insufficient, note the general character needed. This 
report will be made upon the following form : 

Com- Med. Hosp. Actg. Priv- Lit- Ambu- Hosp. Character of Medical 
mand. Offs. Stwds. H. S. ates. ters. lances. Tents. Supplies Needed. 



90 

2. A field hospital will be organized at the Army base as soon 
as possible after landing, and a depot of supplies will be con- 
nected with it. As we are widely separated from the source 
of our supplies a strict economy in their use is necessary ; Sur- 
geons of Divisions and Brigades will give their personal atten- 
tion to this important subject. 

3. Extreme vigilance is enjoined upon Medical OflBcers in 
the matter of camp sanitation ; errors in this particular being 
promptly reported to the respective commanding officers. 

4. The experience at Santiago has demonstrated the effici- 
ency of properly applied first dressings to gunshot wounds ; 
these should be left untouched unti^ the patient arrives at the 
base hospital, unless the condition of the wound absolutely 
demands a redressing en route from the first dressing station. 
All diagnosis tags will be marked "Dressing not to be removed'^ 
or "Redressing required," as the condition demands. Unless 
an imperative necessity exists, surgical operations will not be 
attempted at the front. Chas. R. Greenleaf, Colonel, 

Asst. Surg.-Gen. U.S.A., Chief Surg. Army in the Field* 

QUARANTINE REGULATIONS FOR THE BASE OF THE MILITARY EXPE- 
DITION TO PORTO RICO. 

1. Every vessel shall be officially visited by the inspector before 
communication is made with other vessels or with the shore. 

2. A vessel having yellow fever or smallpox on board shall 
not be allowed to communicate with the shore, or with other 
vessels, but shall leave the island. 

3. Vessels coming from sources of infection shall be detained 
five days without communicating either with the shore or with 
other vessels. If at the expiration of this time no cases of 
fever shall have developed, landing may be made under the fol- 
lowing precautions : 

All fomites shall be disinfected by one of the following 
methods : Immersion for one hour in 1-1000 solution bichlorid ; 
sulphur fumigation in a chamber twenty four hours, four 
pounds of sulphur being used for each 1000 cubic feet of space ;. 
or boiling half an hour with complete immersion. The follow- 
ing need not be disinfected unless directly exposed to infection : 

All new and dry material unpacked, all iron and steel imple- 
ments, all goods in new and original packages, not having been 
broken or packed in an infected locality. Goods other than 
textile contained in textile material, such as coffee in sacks, 
bacon, spices, etc., kept dry and not broken in an infected 
localit> do not require disinfection other than the container, 
which shall be treated as fomites as above. Fruits, sound, 
unless exposed in an infected locality need no disinfection. 
Live stock may be admitted. 

Such ships shall be thoroughly cleaned and disinfected by 
the free use of 1-1000 solution of bichlorid, and by fumigation 
with sulphur before they may again receive men or supplies. 



91 



Ships quarantined shall display the usual flag, and those in 
detention shall be visited by the inspector daily until the time 
of quarantine shall have expired. 

4. Vessels carrying passengers or having fomites from local- 
ities of infection, though they (the vessels) may hail from 
healthy ports, shall be subject to the same quarantine restric- 
tions as vessels known to hail from infected localities. 

5. Due precaution shall be taken to prevent infection of the 
base of supplies through communication with infected localities 
along the line of march by teamsters and others. As far as 
possible they should not be allowed to remain at the base 




Ambulance train transporting the sick from the Division Hospital to 
the Spanish military hospital. 

longer than necessary to load and unload, nor to come in such 
contact as to communicate infection. Stragglers, prisoners 
and strangers should be immediately sent away. 

Chas. R. Gree>'leaf, Colonel, 
Asst. Surg.-Gen. U.S.A., Chief Surg. Army in the Field. 

Major Woodbury was appointed Sanitary Inspec- 
tor. He met with the hearty co-operation of the city 
authorities of Ponce in the performance of his oner- 
ous and often unpleasant duties. The sanitary con- 



92 

ditions of the city underwent a great improvement in 
a few days. The water-supply was found satisfactory. 
The absence of a sewerage system threw many ob- 
stacles in the way. The appearance of smallpox in a 
village some distance from Ponce made vaccination 
among the soldiers who were not protected against this 
disease and the natives necessary. An abundant sup- 
ply of vaccine virus was on hand and was at once 
issued and used. When I arrived at Ponce, August 
7, 1 found typhoid fever raging to an alarming extent. 
It was desirable to trace the origin of the disease. 
The absence of typhoid fever this season of the year, 
its outbreak in all the commands, and the short time 
that had intervened between leaving the United States 
and the landing in Porto Kico made it probable that 
the disease could be traced to the infected camps 
occupied by the troops before leaving for Porto Rico. 
General Miles was very anxious to obtain reliable 
information regarding the origin and spread of the 
disease. Pursuant to the following order I made an 
exhaustive and systematic investigation: 
Headquarters oe the Army, Office of the Chief Surgeon. 

Port Ponce, Porto Rico, Aug. 10, 1898. 
Lieut. -Col. Nicholas Senn, Surgeon U. S. V., Chief of Oper- 
ating Staff of the Army. 

Sir : — You will proceed to the town of Ponce, visit the mili- 
tary and other hospitals in that town, and such of the camps 
in its vicinity as you may deem necessary, for the purpose of 
investigating and, if possible, determining the cause of typhoid 
and other fevers now prevailing in this army, and report the 
results of your investigation in writing to me. Should you 
find it necessary to have the services of an interpreter, or other 
civilian, to aid in your work, you are hereby authorized to 
employ him, sending the bill to this office for payment. 
Very respectfully, 

Chas. R. Greenleaf, Colonel, 
Asst. Surg. Gen. U.S.A., Chief Surg. Army in the Field. 

I obtained accurate information of two hundred 
fever patients, of which number more than 90 per 
cent, were well-marked typhoid fever, the balance 
malaria and the results of sunstroke. I estimated the 
wi^hole number of fever patients in, and in the imme 



93 



diate vicinity of, Ponce at 250. ' In extending my 
inquiries to General Brooke's command, with head- 
quarters at Guayama, I found about 145 additional 
cases; however, in that locality malaria seemed to 
predominate. Most of the cases came from Chicka- 
mauga by way of Charleston and Newport News. 
The Second and Third Wisconsin Regiments fur- 
nished the largest contingent. Almost every soldier 
in the different hospitals belonging to either of these 




Ambulance unloading the sick at the door of the Club House in Ponce 
used as a temporary hospital. 

regiments suffered from typical typhoid fever, and 
what attracted my attention was that the disease 
appeared to be of a more serious type than in most 
of the men belonging to other regiments. The local- 
ity from which these regiments came, when encamped 
at Chickamauga, must have been badly infected. As 
the result of my investigations, I reported to Col. 
Greenleaf the number of cases found, and that in my 
opinion the disease was contracted in every instance 



94 

before leaving the camps in the United States. In 
view of the fact that most of the cases came from 
Chickamauga, I suggested at the same time that the 
Medical Department should recommend immediate 
evacuation of that camp. In Ponce most of the cases 
found shelter and care in the Spanish military hospi- 
tal, then in charge of Major Ten Eyck, U. S. A. The 
club-house and a school for girls, of the Sisters of 
Charity, were also placed at the disposal of the chief 
surgeon and were sooa filled with patients. Miss 
Chancellor of New York did excellent service as a 
nurse in the former temporary hospital. A conges- 
tion which occurred in the military hospital, and which 
could not be prevented, took place when General Wil- 
son's division moved forward and unloaded at the 
door all of the sick in the Division hospital, some 150 
in number. The overcrowded condition was reme- 
died the next day, when a large number of the more 
grave cases were sent on board the Relief, anchored 
in the harbor of Ponce. Medical supplies were in 
abundance at all times and were freely issued without 
any formality. The Relief, and later the yacht May, 
brought an additional supply, with many delicacies 
for the sick. Milk was bought and freely supplied to 
the sick. It is the irtention of the chief surgeon to 
establish an extensive out-door receiving hospital as 
soon as the tentage arrives, which, according to infor- 
mation received from the Surgeon -General, is now on 
the way. The number of new cases of typhoid fever 
in the Porto Rican army will probably be a limited 
one, and if the troops are recalled as soon as the treaty 
of peace has been signed, we need to entertain little 
fear of the indigenous spread of the disease. 
Arroya, Porto Rico, Aug. 12, 1898. 



TYPHOID FEVER IN THE PORTO RICAN 
CAMPAIGN. 



In Caba our army met as its most formidable enemy 
one of the most dreaded of all infectious diseases — 
yellow fever. The Cuban invasion was characterized 
by hasty action, a lack of organization, and inadequate 
preparation. The last crippled the medical depart- 
ment and is responsible for the early and extensive 
outbreak of yellow fever. In less than two weeks 
after our army landed in Cuba, yellow fever made its 
appearance, and almost simultaneously attacked the 
troops from Siboney, the base of invasion, to the 
trenches before Santiago. In less than two weeks 
from its appearance nearly 500 fever cases, most of 
them yellow fever, impaired the fighting force and 
seriously taxed the limited resources of the medical 
department. Fortunately for the army, that type of 
the disease was mild, the number of deaths few as 
compared with some of the epidemics in the past. 
Under the circumstances, it was fortunate that Santi- 
ago surrendered in time, as the fighting force was 
being rapidly reduced by the invasion of yellow fever 
and the ever-present malaria. In planning the Porto 
Rican invasion the possible repetition of a similar 
experience was taken into due consideration, and 
timely precautions against such an occurrence were 
adopted and carried into effect. So far our troops in 
Porto Rico have escaped yellow fever, but soon after 
their landing, fever cases came into the hospitals at 
an alarming rate. Many of the soldiers were attacked 
on the transports or soon after landing. After land- 
ing in Ponce, August 8, I found at least 250 cases of 
fever in the different hospitals in the city and the 



96 

division hospital near the city limits. Even a super- 
ficial examination sufficed to prove that most of the 
cases were typhoid fever. The time which intervened 
between the departure of the troops from the United 
States and the appearance of fever, made it more than 
probable that the infection did not have an indigenous 
origin. In some of the cases it was difficult, in others 
impossible, to make a differential diagnosis between 
malaria and typhoid fever without the use of the 
microscope, and this invaluable diagnostic resource 
in such cases was unfortunately not at hand. Another 
difficulty we had to contend with was the lack of 
recorded thermometric observations, which, when 
accurately made and systematically recorded, prove of 
such signal service in distinguishing between these 
two febrile conditions. 

Pursuant to an order issued by Col. Greenleaf, chief 
surgeon of the army in the field, I investigated for 
two consecutive days all of the fever cases then in 
the hospitals, for the purpose of locating the origin of 
typhoid fever. In this work I availed myself of the 
kind and able assistance of Dr. M. O. Terry, Surgeon- 
General of the State of New York, and Acting Assis- 
tant-Surgeon Greenleaf, son of the chief surgeon. 
We made a careful examination of 200 oases of fever 
as they presented themselves, noted the principal 
symptoms and tabulated them (see appended table). 

A careful study of these cases, as well as subse- 
quent developments, furnished adequate proof that 
90 per cent, of them were genuine typhoid fever. No 
further doubt could remain in tracing the infection to 
the camps occupied in the United States. The great 
prevalence of the disease among the troops, affecting 
as it did, more or less, all of the regiments, was a 
source of uneasiness and anxiety on the part of those 
who were in charge of the invasion. Measures were 
taken to secure ample hospital room and facilities for 
the accommodation and proper treatment of those on 
hand and such as might be brought in later. The 
order to General Wilson to take up the march toward 



97 

San Juan made it necessary to evacuate the division 
hospital. All of the patients were transferred to the 
Spanish military hospital in Ponce, which caused the 
temporary overcrowding to which I referred in a for- 
mer communication. The Spanish military hospital 
is a substantial, square, one-story building with a large 
court in the center. It is built of stone, the floors 
being made of cement or brick tiling. It is on a high 
hill near the city limits, from which a magnificent 
view of the city, harbor and surrounding country can 
be obtained. It has a capacity for about 150 beds. 
It required a good deal of labor to make this building 
fit for the reception of patients. Major Dooly and 
his force worked persistently a whole day in removing 
the dirt and filth which the Spaniards had left, in 
their haste in evacuating the city, as an undesirable 
legacy. The hospital was at once supplied with cots, 
bedding and hospital stores. The club-house of the 
city, and a school for girls in charge of the Sisters of 
Charity, were offered to the authorities for hospital 
use, and courtesy was promptly accepted. For over a 
week the sick officers occupied the club-house and 
about fifty patients found comfortable quarters and 
excellent treatment in the school-house. Ponce has 
a large charity hospital, the "Tricoche," with 200 
beds, under the care and management of the Sisters 
of Charity. The hospital is a model of cleanliness 
and comfort. Col. Greenleaf made arrangements with 
the city authorities to open the doors of this excellent 
institution for sick officers. I am sure that every one 
who will enjoy the kind treatment and excellent care 
of the Sisters in these great institutions of charity 
will have a good word for this ancient and worthy 
order. Out of the 200 cases of fever examined in the 
different hospitals in Ponce, and which appear in the 
table, the following diagnoses were made at the time: 
Gastric fever, 2; effects of sunstroke, 6; malaria, 9; 
doubtful, 21; typhoid fever, 162— total, 200. 

I am satisfied that of the doubtful cases a sufficient 
number developed typhoid fever to bring the whole 



98 

number of oases up to 280. In reference to the time 
the disease developed the following can be gleaned 
from the table : The first symptoms appeared before 
leaving the United States, 8; on transports, 86; within 
ten days after landing, 68, out of a total of 162. 

As regards the place of infection the cases came 
from: Chickamauga, 90; Tampa, 48; Camp Alger, 23, 
Newport News, 1 — total, 162. 

The small number coming from Camp Alger, where 
the disease gained such a firm foothold, which led to 
the abandonment of the camp, is to be explained by 
the fact that a large number of fever cases, coming 
from that camp, were returned to the United States 
soon after landing, by order of Col. Greenleaf . All 
regiments were not affected alike by this disease. 
Among the troops in Porto Rico the typhoid fever 
cases were distributed as follows: 

2d Wisconsin 42 

3d Wisconsin 17 

16th Pennsylvania 17 

6th Massachusetts 15 

19th U. S. Infantry 15 

6th Illinois 11 

3d Artillery 10 

4th Artillery 5 

11th U. S. Infantry. 5 

1st Provisional Corps 4 

Hospital Corps 4 

17th U. S. Infantry 3 

2d Cavalry 3 

5th Cavalry 3 

3d Illinois 4 

4th Pennsylvania 2 

Signal Corps. ... 2 

5th Artillery 1_ 

Total 162 

In tabulating the symptoms the following facts 
appear: 

f Dry, coated, red at tip and margin. 10. 
Coated, white fur. 21. 
Coated, pale, flabby. 17. 
Tongue. ^ Coated, red tip and margin. 56. 
I Dry, brown and fissured. 20. 
! Moist, glazed, red. 13. 
I^Sordes, lips and teeth. 12. 



99 

f Tympanites. 29. 

I Tenderness and gurgling right iliac fossa. 71. 
Abdomen. ^ Rose spots. 37. 

I Spleen enlarged. 141. 

[ Spleen markedly enlarged. 20. 

Epistaxis during prodromal stage 28 

Diarrhea ^ 87 

Intestinal hemorrhage 3 

Bronchitis 20 

Delirium 1 

The absence of delirium in all cases but one is 
remarkable, but it must not be forgotten that nearly 
all of the cases were examined during the early stages 
of the disease. In quite a number of cases this symp- 
tom appeared later. From the symptoms and the 
death-rate, ascertainable at this time, it is evident that 
the disease pursued a comparatively mild course. 
Nearly 200 of the more grave cases were transferred 
to the hospital ship Belief, which sailed from Ponce 
for New York August 15. Of this number fourteen 
died en route and twelve were buried at sea. In two of 
these cases death resulted from complications. In 
one case gangrene of the penis, which assumed a pro- 
gressive form, was the direct cause of death. In one 
case a fatal termination threatened during the third 
week of the disease from laryngitis and lobular pneu- 
monia. A metastatic abscess of the submaxillary 
gland, which developed in one case, deserves mention 
as a rare complication of typhoid fever. 

KETURN OF THE HOSPITAL SHIP " RELIEF " FROM 
PORTO RICO. 

The Relief sailed from Ponce, Porto Rico, August 
15, for New York, and called on her way at Mayaguez 
to complete her precious cargo of sick and wounded. 
All of the wounded at the last port were taken on 
board. The entire number of patients on leaving 
Porto Rico was 255, the full capacity of the floating 
hospital. It is probably the first time in the history 
of the world that so many fever cases were treated on 
a hospital ship and conveyed from a foreign country 
to their homes. The first day out a brisk breeze 



100 

caused considerable rolling and pitching of the ship, 
which induced some cases of seasickness among the 
patients, but did not seem to unfavorably influence 
the disease. The female nurses worked faithfully and 
proved of the utmost value to the sick. Fourteen of 
the more severe cases of typhoid fever died on the 
way to New York. Many of the patients improved 
rapidly during the voyage. The Belief has done all 
and more than was expected in serving as a temporary 
hospital and as an ambulance ship in the treatment 
and transportation of the sick and wounded. 

New York, Aug. 20, 1898. 



THE RETURNING ARMY. 



The war is over and the heroes who freed the West- 
ern Continent from Spanish despotism are returning 
home. The first war of invasion on our part has been 
a short, decisive one. Only four months have passed 
by since the Chief Executive issued the first call to 
arms, and more than we expected has been accomp- 
lished. The outside world, which has sneered too 
long at our fighting strength as a nation, has been 
convinced that it is dangerous to trifle with Ameri- 
cans in matters of war. In less than two months after 
war was declared we had more than two hundred 
thousand men in the field, eager and anxious to face 
the dangers of active warfare. Less than one-half of 
this army took part in the invasion. The enemy's 
navy was entirely destroyed; not a single ship that 
came within range of our guns escaped. The proud 
Spanish fieet is a total wreck in American waters, a 
source of pride to our navy and a significant object 
lesson for all foreign nations. Santiago fell before 
our victorious army ; Porto Rico yielded after a few 
skirmishes and Spain accepted our terms of peace 
without much argumentation, after the hopelessness 
of her cause had been demonstrated by our invincible 
army and navy. Peace has been restored, and the 
returning soldiers of the volunteer army will soon 
return to citizenship and resume their ordinary voca- 
tions of peaceful life. 

What a contrast between the invading and return- 
ing army! This contrast has reference not only to 
size but also to appearance. Thousands have died 
from wounds and disease. Yellow fever, dysentery, 
malaria and typhoid fever have been and continue to 
be our most formidable enemies. We had no great 



102 

difficulty in silencing the Spanish guns, but we have 
been less effective in preventing the origin and spread 
of these, the greatest terrors of camp life. We can 
calculate with some degree of precision the loss of life 
sustained in battle, but it is impossible today to esti- 
mate the ultimate damage inflicted by disease. The 
naval forces scored the greatest victories with little 
loss of life; they escapsd disease and its consequences, 
to a large extent, and were subject to little or no pri- 
vations. The invading armies suflPered the brunt of 
privation and discomforts incident to an active cam- 
paign. The troops in camps who were denied the 
privilege of taking part in the invasion of Cuba and 
Porto Rico had their share of deaths, sickness and 
hardship. It is safe to say that not half of the soldiers 
engaged in this short war are in a fighting or working 
condition on their return home. It is a sad sight, 
indeed, to witness the disembarkment of a transport 
arriving from Cuba or Porto Rico. Every one of the 
vessels brings from fifty to one hundred and fifty dis- 
abled men requiring medical treatment. All of the 
men left on the outgoing transports in good health 
and cheerful mood; all who arrive show the effects of 
the campaign. Many have died in our new posses- 
sions, many have been consigned to the sea on their 
way home, others have reached the shore in a dying 
condition. The crowded transports, the inadequate 
provisions for proper food, have made the voyages to 
and from the seat of war a source of hardship instead 
of health and pleasure. The emaciated forms, the 
sunken eye, the hollow cheek, the pale, bronzed faces, 
the staggering gait, show only too plainly what can 
be done by disease, a tropic climate and improper 
food in disabling an army in a few weeks. In this 
respect our experience is a repetition of that of our 
enemy. It is well known that the Spanish army lost 
50 per cent, of its fighting force from the same cause 
in two months after landing in Cuba. The Spanish 
surgeon I met inside of the lines of the enemy, four 
days before the surrender of Santiago, when we deliv- 



103 

ered to him, under a flag of truce, sixteen wounded 
Spanish soldiers, informed me that when his part of 
the army reached Cuba the men were all in good 
health, and that now many were sick and none well. 
He drew a sad picture of how their ranks were 
thinned out by yellow fever, malaria and dysentery. 
The outbreak and spread of typhoid fever in our 
home camps, so early during the campaign, is respon- 
sible for more deaths and suffering than any other 
cause. Many of our soldiers carried the infection 
with them to Cuba and Porto Rico, and were taken 
ill on the transports or soon after landing. It is 
much more difiicult to keep typhoid fever out of the 
army than yellow fever. The yellow fever which our 
troops in Cuba encountered was of a mild type. 
Comparatively few died and most of the cases recov- 
ered after an illness of but a few days. Typhoid fever 
runs its typic course of three weeks or more, little 
influenced, as far as time is concerned, by medication. 
It is a disease which, above all others, requires care- 
ful nursing. The necessary attention to typhoid- 
fever patients in nursing and treatment is a matter 
difficult to obtain, even in a well- equipped hospital 
with all needful appliances. The management of 
such cases in field hospitals is necessarily attended by 
many difficulties which tax to the utmost the experi- 
ence of the medical staflP and nursing corps. Consid- 
ering the limited resources at our command in the 
treatment of this disease, in our home camps and our 
new possessions, it is surprising that the mortality 
has not been greater. The Sisters of Charity and the 
trained female nurses from different cities, have done 
most satisfactory work in our home camps, crowded 
with typhoid fever patients. Many a soldier on his 
recovery from the disease will feel grateful for their 
faithful services. 

CAMP WIKOFF. 

Camp Wikoff is now a great hospital. It is located 
on Montauk Point, L. I., a narrow strip of land sur- 
rounded on both sides by salt water. The country is 



104 

hilly and treeless and the sandy soil is covered with a 
scanty growth of grass. Between the hills are cup- 
shaped depressions with a marshy soil, which after 
rains are filled with stagnant water. These diminu- 
tive marshes threaten danger in case of a prolonged 
encampment. They are undoubtedly, all of them, 
the natural breeding-places of the plasmodium mala- 
riae. They will soon become contaminated with the 
fecal discharge from huudreds of typhoid fever cases, 
as many of the sinks drain directly into them. I am 
told that the water-supply from the artesian wells, 
while not ample, is otherwise satisfactory. The small 
railroad which terminates here from New York, 
monopolizes the whole business of transportation, as 
this exclusive right was made conditional in securing 
the ground for camp purposes. This is greatly to be 
regretted, as steamer communication could be readily 
established, which would facilitate the present 
unusually large passenger and freight business be- 
tween the camp and New York. Politics and personal 
interests have figured conspicuously in the manage- 
ment of the present war. Departments have been 
severely criticised, when a thorough investigation 
would often reveal a power behind the throne. If we 
had steamer traffic between here and New York we 
would not have to wait for days for the so much 
needed supplies. The little railroad has had sufficient 
infiuence in cutting off competition and in increasing 
correspondingly the value of its stock, and we here 
are suffering the consequences of this Judas Iscariot 
bargain. The whole little peninsula is a tented field. 
Regiment after regiment is arriving, day after day, 
seriously testing the quartermaster's department. All 
the troops that came from Cuba must land here to 
comply with the quarantine regulations. A detention 
hospital has been established near the landing, to 
which all suspects are consigned for the required 
length of time. Near the hospital a large disinfect- 
ing plant has been erected. So far no cases of yellow 
fever have been imported. The general hospital con- 



105 

tains at the present time (August 26) nearly one 
thousand patients and all the sick in the camp will 
swell the number to 1500. The landing of so many 
sick in such a short time has brought about an over- 
crowding which, with the present facilities and re- 
sources could not have been prevented. Colonel For- 
wood, Assistant Surgeon- General, selected the camp 
site, and was the first man on the ground. His 
immense military experience, gained during the War 
of the Rebellion, fitted him in an admirable way for 
the difiicult task imposed upon him. Colonel For- 
wood is an authority in military surgery and endowed 
with excellent administrative talents. His work here 
will be the crowning efiPort of his life. He has worked 
night and day since he has assumed his duties here. 
He is a friend of the soldier and will not leave a 
stone unturned to be of service to him. He has exclu- 
sive charge of the hospital construction, and his work 
was much admired by two staff surgeons of the Grer- 
man army, Drs. Steinbach and Wildemann, and by 
Lieutenant-Commander Tomatsuri of the Japanese 
navy, who came from New York to the camp with me. 
As they expressed themselves, the field hospitals here 
were the best they had ever seen. Colonel Forwood 
is ably assisted in his arduous duties by Majors Heitz- 
mann. Brown, Nancrede and Wing and a large staff of 
acting assistant-surgeons. The writer, on his arrival, 
was placed in charge of the surgical work. An oper- 
ating tent was erected and placed in working order 
with the assistance of two Sisters of Charity and 
Acting Assistant-Surgeon Greenleaf. The tent is 
floored and divided into four sections. The front part 
is the operating-room, with two side tables two feet 
in width the whole length of the room. The tables 
are covered with rubber cloth. An army operating- 
table and a few stands constitute the balance of the 
furnishing of the room. The next section is open on 
the sides to allow a free current of air and serves as 
an office. The next compartment is the preparation- 
room, fitted out with formaldehyde and steam steri- 



106 

lizers and sufficient shelf accommodations. The last 
section is used as a storeroom for dressings, splints, 
antiseptics and drugs necessary for the treatment of 
surgical cases. 

Gen. Joseph Wheeler is in command of the camp,, 
and although debilitated by the campaign and disease^ 
he attends to his duties wtth a regularity and devo- 
tion which have characterized his whole military 
career. The sick are being cared for at the present 
time by fifty Sisters of Charity and sixty trained 
female nurses. One of the things that was greatly 
admired by the foreign military surgeons was the 
efficient work of the hospital corps. They were 
charmed with the way in which the patients were 
handled and the gentlemanly conduct of the litter- 
bearers. Less praise was bestowed on the military 
bearing of the men in camp, from the highest officers 
to the ordinary private. The military spirit seems 
to have been fully subdued in the enemy's country. 
The sentries move about sluggishly and seldom deem 
it worth while to come to a "present arms," no matter 
who may come within saluting distance. Men walk 
about in clothes showing only too distinctly the 
absence of whisk-broom or brush since they left Cuba. 
Gruns, bayonets and scabbards have become rusty and 
show an entire lack of proper care. All drills are sus- 
pended and the whole camp presents more the appear- 
ance of a picnic ground than a military post. Officers 
and men are evidently impressed with the idea that 
their work is done, and while away their time in a 
way requiring the least amount of energy and exertion 
possible. In this respect our troops form a strong 
contrast with the German army w'hen it entered Paris, 
after one of the most bloody wars and after a prolonged 
siege full of hardship and privations. On that occa- 
sion every soldier was in a condition to go on parade 
and to pass with credit the inspection of the most 
exacting officer. Such looseness of discipline as seen 
here at this time is not calculated to inspire the out- 
going army with the proper military spirit that should. 



107 

be maintained and cultivated under the most adverse 
circumstances. Strict military bearing is also sadly 
lacking among the medical officers — a source of dis- 
appointment and surprise to the corps of acting 
assistant- surgeons, who entered the service with the 
full expectation that the reverse would be the case. 

Camp Wikoff, Montauk, N. Y., Aug. 27, 1898. 



THE NATIONAL CRY. 



Unrest, criticism and grumbling are the accom- 
paniments and heritage of every war. These symp- 
toms of war fever have been unusually well developed 
during the war just ended, and they will be discussed 
for a long time after the treaty of peace has been 
signed. After an uninterrupted reign of peace for 
more than thirty years, the war cloud that came upon 
us so suddenly and unexpectedly provoked a commo- 
tion among the people unparalleled in degree and 
extent since the War of the Kebellion. All eyes were 
turned in the direction of the seat of war, and the 
contents of our enterprising and prolific newspapers 
were devoured with an eagerness unknown in any 
other country. It is strange that with all this great 
national unrest the current of commerce and business 
pursued its natural course. While our troops were 
engaged in war in foreign lands, the tilling of the 
soil, the hum of industry and the ordinary avocations 
of life continued as though harmony and peace 
reigned universal. The American never forgets that 
patriotism is not limited to the battlefield. The con- 
scientious performance of duties at home, the fireside, 
the farms, the w^orkshops, the manufacturing and busi- 
ness places, is one of the things essential in the suc- 
cessful prosecution of a war. This fact was recognized 
by our people, and the result has been that the pros- 
perity of our country has suffered little, if any, during 
our first war of invasion. Criticism is a part of human 
nature. It is seen everywhere. It affects the educated 
as well as the ignorant, it extends from the cradle to 
the grave, it involves one sex as much as the other, it 
moves the well as much as the sick, it infects the pulpit 
as well as the stage, and it comes to the surface in the 



109 

army from the commanding general down to the lowest 
of all privates. It is amusing to listen at a camp fire 
to the remarks made from all sources as to how the cam- 
paign should be conducted. The average private dis- 
cusses the most complicated strategic problems with an 
ease as though he were repeating the multiplication 
table or the Lord's prayer. The generals high in com- 
mand ease their conscience by criticising their subordi- 
nates most unmercifully, if any thing has gone wrong. 
Wise as well as ignorant men, a thousand miles away 
from the seat of war, have their convictions as to 
what should be done and are free to express them. 
Criticism increases in severity and extent in propor- 
tion as confidence is weakened and undermined. As 
we live in a free country criticism finds a fertile and 
productive soil everywhere and anywhere. The un- 
bridled liberty of the press encourages and fosters it. 
Like swearing and other vices it is engendered by 
environments. Just and wrathful criticism is legiti- 
mate; criticism the outpouring of impure selfish mo- 
tives is baneful. Our energetic, enthusiastic press is 
entitled to a great deal of credit in giving to the pub- 
lic the war news so promptly and completely, often at 
an enormous expense and severe danger to life. The 
American reporter has no equal in any country for 
obtaining news regardless of cost and risk. The 
reporters not only culled the news, but often took a 
hand in supplying the sick and wounded with fruit, 
tobacco, and delicacies. How quickly the reporters 
snifPed the latest news, I learned in Porto Kico. I 
arrived from Arroya in the harbor of Ponce, August 
13. Rumors of peace were rife for a number of days. 
The Herald dispatch boat, then in the harbor, got 
up steam at about 3 o'clock in the afternoon. Soon 
the little craft put to sea, and I watched its course with 
intense interest. I said to my friends, if the boat, 
after leaving the harbor, turns in the direction of 
Arroya, it means war; if in an opposite direction, 
toward New York, peace has been declared. The 
proud little steamer turned its nose toward the United 



110 

States and made a bee line for New York. It was not 
until the next morning that the welcome news reached 
headquarters. This is only one of the many instances 
in which the reporters came in possession of the latest 
news before they reached the officials. The reporters 
were also instrumental in exposing many irregulari- 
ties and defects of the military service from head- 
quarters in Washington to the seat of war. I have 
no doubt that many wrongs were corrected under the 
pressure of the press. 

It is not strange that many of our influential news- 
papers went a little too far in representing the griev- 
ances of the soldiers and in criticizing the action of de- 
partments and officers. A tinge of sensationalism is 
common more or less to all of our great dailies. Inter- 
views that never occurred will continue to appear as 
long as the reputation of a reporter depends largely 
on his ability to satisfy the cravings of morbid curi- 
osity. The statements made to reporters are always 
susceptible to more or less reconstruction. Again, it 
must be remembered that some men in the army, as 
elsewhere, are likely to exaggerate the true conditions, 
believing that by doing so, their services will be the 
better appreciated. As the result of my own obser- 
vations, I can say without fear of contradiction that 
the best soldiers do the least grumbling. The most 
heroic and patriotic soldiers have the least to say of 
what they did and in relating hairbreadth escapes. It 
is the drone that does the complaining, and who rides 
in ambulances, and overcrowds the hospital, and puz- 
zles and vexes the hard-working doctor. To the 
credit of the armies of invasion I must say that I 
heard but few complaints when the days were darkest 
and the food scantiest. One day I visited the fever 
camp near the division hospital of the army before 
Santiago, where I found two hundred patients liter- 
ally lying in the mud, with nothing but a wet blanket, 
most of them under a shelter tent, some of them even 
without this slight protection against the pouring 
rains. Food was of the plainest kind, yet little or 



Ill 

no complaint here. The men expected hardships, 
and when they came they were not disappointed. 
Grumbling became more marked and widespread 
with the progress of the war, after the men had be- 
come worn out by the campaign, and homesickness 
had gained a firm foothold. The severest complaints 
have originated with camp followers. The Medical 
Department has been criticized repeatedly, and yet 
it would be found very difficult to find among the re- 
turning soldiers any one who would be willing, or 
who would have reason to complain of the treatment 
he received at the hands of medical officers. In 
case of war, the machinery of our government is 
a very complicated one. The executive power of 
the Surgeon-General is indeed an extremely limited 
one. Everything of importance has to pass 
through the hands and by sanction of the Secretary 
of War. The Secretary of War is a busy man in keep- 
ing track of what is going in his department outside 
of the Surgeon-General's office. On the other hand 
the Medical Department depends entirely on the quar- 
termaster's department in forwarding and distributing 
medical supplies. No wonder that many collisions 
between these departments occurred during the pres- 
ent war. Our experience has taught us in a most 
forcible way that the Medical Department should have 
charge of everything pertaining to the sick and 
wounded, in order to accomplish that for which it is 
intended. The Secretary of War is not supposed to 
have any knowledge of medicine or surgery or other 
wants of sick and wounded, and yet the Surgeon- 
General is powerless in the execution of his orders 
without his co-operation. If the forwarding and dis- 
tribution of the medical and hospital supplies were 
directly under the control and management of the 
Medical Department we would have heard less of well- 
founded complaints of the scarcity of medicines and 
hospital supplies. To make a department strong and 
efficient it must be independent. It was not difficult 
to foresee when this war broke out that the greatest 



112 

danger the troops had to expect was disease and not 
the Spaniards. The importance of the Medical De- 
partment was never more keenly apparent than at the 
present time, and yet what was done? The highest 
official in the Medical Department is a Brigadier- 
General, and only five medical officers with the rank 
of Colonel, and seven Lieutenant-Colonels. For the 
army major-generals were in abundance, brigadier- 
generals by the dozen, and colonels were turned out 
by the hundreds. Many of the brigadier- generals in 
brand new uniforms and glittering staffs never found 
a command, but their names remained on the pay 
roll just the same. Many of our newly fledged 
colonels could not handle a musket to save their 
lives and some of them even attempted the unusual 
feat of mounting the horse from the right side. In 
the face of all these appalling defects of army service 
the brunt of criticism continues to fall on the Sur- 
geon-General and his hard w^orking officers in the 
field. Much has been said of the mismanagement of 
Camp Wikoff. Considering the limited transporta- 
tion facilities, and the fact that in less than three 
weeks more than 3,000 patients have been cared for, 
it is a source of gratification that so much has been 
accomplished, largely through the energy of the Chief 
Surgeon, Colonel Forwood, and 'Majors Brown and 
Heitzman. A corps of more than one hundred female 
nurses, including fifty Sisters of Charity, do the nee 
essary nursing with a will and efficiency that aston- 
ish the many visitors. The hospital tents go up like 
mushroons, day after day, and at the present time 
2000 patients are well sheltered and well cared for. 
No lack of medical supplies at this time. The sur- 
gical ward in my charge w^as completed today and is 
already crowded with patients. The liberal contribu- 
tions sent here by different relief societies supply the 
sick and well with an abundance of delicacies of all 
kinds. The diet of the convalescents is luxurious, 
much better than what is furnished by the officers' 
mess. The Red Cross is doing excellent work here, 



113 

as elsewhere, in the distribution of clothing, medi- 
cines and delicacies. Mrs. A. Tscheppe, who repre- 
sents a relief society of New York, is a familiar figure 
among the soldier patients and has been of much ser- 
vice in adding to their comfort and speedy recovery. 
Most of the patients are suffering from malaria, 
typhoid fever or dysentery. The number of deaths 
average from ten to fourteen daily, a small percent- 
age considering the number of patients in the whole 
camp. The patients here enjoy fresh air, good nurs- 
ing and excellent treatment, all of which will be con- 
ducive to rapid recovery. The conditions here for 
the successsul treatment of the fever cases are, in my 
opinion, far better than in any of the large hospitals 
in cities. It is to be hoped that the entire camp will 
be vacated in from four to five weeks, as after that 
time the soil will be thoroughly infected, in spite of 
all precautions, and the indigenous spread of typhoid 
fever would follow as an unavoidable sequence. The 
surgical work consists in the treatment of large 
abscesses, occurring in patients whose general 
health has been undermined by disease, or the 
hardships of the campaign, and operations for 
hemorrhoids and rectal fistula. Unjust and unnec- 
essary criticism has a demoralizing effect on those 
directly or indirectly concerned. It is prone to 
intimidate and confuse those who are criticised 
and embolden those who look for undeserved 
sympathy. In this camp there is no further 
ground for complaint of any kind. It is gen- 
erally known that the Medical Department was 
not consulted in locating the camps. For reasons 
known only to those in power, the camps were selected 
regardless of sanitary conditions. Our troops have 
been exposed to malaria since they left the State 
camps, and almost every man shows evidences of more 
or less malarial poisoning. As the essential cause of 
malaria enters the body by inhalation, malaria could 
not be avoided as long as the camps were located on a 
soil which breeds the plasmodium. Typhoid fever 



114 

made its appearance in the State camps and followed 
the army to Chickamauga, Tampa, Alger, Cuba and 
Porto Rico. It is a repetition of what has happened 
during all campaigns under similar circumstances. 
Let the national cry subside now and let the press 
and people await the results of a thorough investiga- 
tion by Congress, which will place the responsibility 
for any mismanagement where it belongs. The Med- 
ical Department courts such investigation, fully con- 
fident that the blame will be fixed outside of its legit- 
imate jurisdiction. 

Camp Wikoff, Aug. 31, 1898. 



OUR RELIEF SOCIETIES. 



War, pestilence, famine, floods and other great 
national calamities, are the most reliable tests to bring 
out the true philanthropic spirit of individuals as well 
as of nations. The good Samaritan is to be seen every- 
where under ordinary conditions on his errands of 
mercy, following the footsteps of his Master in bring- 
ing comfort to the poor, the sick, the maimed and the 
oppressed, but his energies are taxed to the utmost, 
and his work is appreciated most keenly, when the 
masses are in distress. The American people are 
noted for their charitable disposition, and have gained 
a well-deserved reputation for humanitarian work. 
Our numerous ideal charitable institutions speak for 
themselves. Many national catastrophes have demon- 
strated the liberality and good-will of our people. 
The War of the Rebellion furnished an interesting 
object lesson to the outside world of the way in which 
patriotism is estimated here. During the war just 
ended many different relief societies have rivaled with 
each other in supplying our soldiers, sick and well, 
with many comforts of life beyond the limit of the 
government supplies. The government itself set a 
noble example by sending to the camps and the in- 
vading armies all kinds of supplies, unparalleled in 
quantity and quality in the history of the country. 
I am sure no one regrets more keenly than the gov- 
ernment ojEcials that these liberal supplies did not 
always reach their destination in time. The work of 
the many auxiliaries corrected many of these defects. 
Individuals as well as organized societies have labored 
incessantly and faithfully in coming to the aid of the 
government, in furnishing the troops with under- 
clothing and delicacies usually beyond the reach of 






!m| iojb:: — :jm1i!, : 






116 

armies when engaged in active warfare. Miss Ana- 
bel Clarestes, a little girl in Lagrange, 111., has been 
busy ever since the war commenced in preparing and 
sending to camps and the front home-made jellies, 
the product of her own hand. She had no difficulty 
in collecting money to purchase the necessary mate- 
rials, but it was left for her to labor in the humble 
kitchen to prepare the incomparable delicacies for the 
soldiers in the field. This little American girl is a 
heroine worthy of the praise and admiration of the 
returning heroes who have been benefited by her 
modest, unselfish work. Many a patriotic woman, 
unknown to newspaper notoriety, has done her share 
in minimizing the sufferings of this war. It was not 
an uncommon thing for officers to receive a box con- 
taining the contributions of some female friend of 
the army who sent all she could spare for the allevia- 
tion of the troops in the field. In many such instances 
the name of the benefactress remained unknown to 
those who benefited by her donation. I have opened 
many such boxes, containing as a rule underclothing, 
bandages, reading and writing material, towels, hand- 
kerchiefs, and a few jars of jelly or canned fruit. The 
soldiers who were made the recipients of these gifts 
felt that they were remembered at home, an assurance 
which contributed much in intensifying their patri- 
otism and in sustaining their courage under the most 
trying circumstances. The intense interest manifested 
by the government and the people in the care and 
comfort of the returning army remains unequaled in 
the history of our country. Every soldier was met 
with a reception given to an intimate and long-looked- 
for friend. The sick received the most tender care 
from all sides, and the well were given food that re- 
minded them that they had reached home. The hos- 
pitals and many private houses threw the doors wide 
open to receive those who required medical treatment. 
Transportation home was made easy and comfortable 
by the active intervention of thousands of friends 
who were strangers when the troops left for the seat 



117 

of war. In all large cities committees were organized 
to look after the comforts of the returning troops. In 
short, it may be safely stated that no army ever 
received a more enthusiastic, kind and cordial recep- 
tion than the troops that have reached us from the 
seat of war. 

RED CROSS SOCIETY. 

Miss Clara Barton, President of the American Red 
Cross Society, has performed her onerous duties dur- 
ing the entire war with a devotion and earnestness 
that merit universal recognition at home and abroad. 
She has been tireless in her efforts to bring comfort 
to the soldiers at times when her services were most 
needed. The Texas Siud the little steamer Bed Cross^ 
under her command, made their appearance at Sibo- 
ney at a time when outside help was most appreciated. 
Ice, medicines, dressings and hospital supplies were 
freely distributed among the sick and wounded. 
After the surrender of Santiago the Texas was the 
first vessel to enter its harbor on its errand of mercy 
in bringing food for the hungry Cubans and delicacies 
for the sick of the victorious and vanquished armies. 
The Red Cross Society established supply depots in 
all of the large camps and the good work done every- 
where will live in the memories of all who were 
engaged in the conflict. Miss Barton has the confi- 
dence of the American people and she has sustained 
it through the present war by the thoughtful and 
timely distribution of the innumerable and liberal 
donations to the society she so well represents. An 
appropriate idea of what this Society has done can be 
gained from the fact that in Camp Wikoff alone two 
thousand dollars of supplies are distributed daily. 
Miss Barton has been assisted in her widespread 
humanitarian work by a large staff of physicians and 
nurses who came to the relief of the medical officers 
at times when their services were most needed. After 
peace was declared. Miss Clara Barton immediately 
sailed for Havana to bring much-needed aid to the 
starving reconcentrados of the long-besieged city, 



118 

while her numerous helpers continued their faithful 
work in the home camps. The work of the Red 
Cross received the moral and substantial support of 
the charitably disposed citizens throughout the 
United States and liberal donations from abroad. 
Recent experience has again demonstrated that this 
society is the most important auxiliary in war as well 
as other natural disasters in bringing prompt relief to 
the sufferers. 

women's patriotic relief association, new YORK. 

This benevolent Association has extended its work 
from the camps to the needy families of soldiers who 
enlisted and went to the front, leaving families behind 
them, worthy objects of well-deserved charity. It was 
founded in the City of New York at the outbreak of 
the war, at the residence of Mrs. Egbert Gurnsey, 
with Mrs. Howard Carroll as president and well- 
organized committees and ad^ 3ory board, consisting 
of prominent business and professional men. The 
Association has provided food and house rent, as well 
as medical attendance, monthly, to no less than 2444 
families. A free eatinghouse was established at 711 
Eighth Avenue, where these families received food 
and clothing. Mrs. Charles Carroll, a member of the 
Association, was made president of the Naval Reserve 
Relief, and by contributions and a garden party given 
at her residence in New Brighton, Borough of Rich- 
mond, the sum of $2500 was secured, which was 
expended for the benefit of the New York Naval 
Reserves. This special function of the Association 
did much for the comfort and efficiency of this other- 
wise neglected branch of the military service. The 
hospital work of the Association has been under the 
management of Mrs. Charles Carroll, Mrs. Adolph 
Tscheppe and Mrs. Seymore. The ladies of the 
Association, with Mrs. William McDonald as chair- 
man, gave an outing to the convalescent soldiers 
from the different hospitals in Central Park, which 
proved to be one of the most memorable occasions in 



119 

the annals of the history of this famous park. Mrs. 
Charles Carroll and Mrs. Tsoheppe erected a tent in 
Camp Wikoff when the soldiers from Cuba com- 
menced to return, and have been busy in distributing 
without any red tape an enormous amount of most 
valuable contributions among the sick and convales- 
cents. Their donations of different stimulants and 
artificial waters have proved most acceptable and 
timely. From this tent ice cream has been furnished 
daily. A special messenger has done excellent service 
in distributing mail and in looking up soldiers 
inquired after by anxious relatives. So fertile have 
been the resources of this modest little tent that 
it has been designated "The Gold Mine." Mrs. 
Tscheppe represents the ladies of the "Liederkranz," 
and her popularity among the Germans of New York 
has brought not only the most liberal donations but 
likewise cash in large amounts. Only the other day 
she received from a single source a check for $500, 
which she was asked to use at her own discretion in 
the care of the sick and convalescent in the camp. 
The German press of New York has used its influence 
in supplying Mrs. Tscheppe with ample means on her 
errands of mercy. 

ILLINOIS ARMY AND NAVY LEAGUE. 

This relief association was organized soon after war 
was declared. It is composed of representative men 
and women throughout the State of Illinois, with head- 
quarters in Chicago. The secretary, Dr. F. H. Wines, 
had an extensive experience in dispensing charity 
throughout the War of the Rebellion, and was conse- 
quently well prepared in assuming the laborious and 
trying duties of his office. While it was the principal 
intention of the association to look after the interests 
and comforts of the State Volunteers, many of the 
contributions reached soldiers outside of the Illinois 
troops. The State of Illinois, and the City of Chicago 
in particular, have been very activ^e in minimizing the 



120 

inevitable sufiferings incident to active warfare by 
sending to the camps and the front large quantities 
of the most desirable articles of diet, delicacies, under- 
clothing and medicines. The League made special 
arrangements for transportation at reduced rates, so 
that the donations reached their destination promptly 
and at small expense. The League has had from the 
very beginning a handsome bank account, and cash 
was sent to different points for the purchasing of the 
most necessary articles. The citizens of Illinois will 
have the satisfaction of showing that by concerted 
action of the members of the League the work of 
charity and benevolence has been accomplished in 
the most satisfactory manner. 

MASSACHUSETTS VOLUNTEEK AID ASSOCIATION. 

There has been an impression prevailing among the 
regular troops, that while the soldiers of the regular 
army have fought the hardest and have been sub- 
jected to the greatest privations, they have not re- 
ceived the recognition to which they are entitled, and 
have been more or less ignored by the different relief 
associations. There is undoubtedly som^ truth con- 
cerning these statements. The Massachusetts Vol- 
unteer Aid Association has recognized the validity of 
this complaint, and has directed its surgeons toward 
correcting the oversight. The work of this associa- 
tion in this direction has been particularly notable in 
Camp Wikoff*. A number of ladies representing this 
Association came to the camp, and have done all in 
their power to render the soldiers belonging to the 
regular army comfortable and happy. 

A light diet kitchen was established, provided and 
equipped at the First Division Hospital, in charge of 
Major Wood, in conjunction with the Red Cross Soci- 
ety, under the superintendency of Mrs. M. H. Willard. 
The kitchen is an ideal one, and is presided over by 
a competent chef. Mrs. Dininger is the lady mana- 
ger. The bountiful donation for the sick of the Regu- 
lar Infantry Division was brought to the camp by 



121 

Mrs. Leach, wife of Major Smith S. Leach, of the 
Engineer Corps of the Kegular Army, and was con- 
tributed by the ladies of New London, Conn., and the 
Pequot Society. It consisted of a well- assorted col- 
lection of soups, eggs, lemons, oranges, butter, crackers, 
sugar, barley, cocoa, farina, beef, ham, corn- starch, 
codfish, breakfast food, chocolate, gelatin, tobacco, 
pipes, keg of whisky, writing and reading material, 
towels, pajamas, night- shirts and underclothing. The 
light-diet kitchen is one of the attractions of the camp. 
The relief societies that I have mentioned are only a 
few of the hundreds organized throughout the United 
States for the same purpose, notably among them the 
^'Daughters of the Revolution" and the ''Colonial 
Dames," all of which did their good share in allevia- 
ting the sufferings of our army in camp and at the 
front. The charity that has been practiced so boun- 
tifully and so generally during the present war, must 
satisfy our victorious army that the patriotism they 
carried into the field has been cultivated at home in 
words and action to a degree and extent unparalleled 
in the history of the world. War in a just cause be- 
gets patriotism, and nothing can demonstrate this 
more clearly and forcibly than our experience in the 
field and at home during the last five months. 
Camp Wikoff, Sept. 8, 1898. 



THE WOUNDED OF THE PORTO RICAN 
CAMPAIGN. 



The Cuban and Porto Rican invasions have con-^ 
firmed the experience of the past in showing that the 
greatest horrors of war are caused by disease and its 
consequences rather than the implements of destruc- 
tion. If the battle-grounds are in the extreme north 
or south, climate enters as an important factor in 
decimating the ranks and in increasing the sufferings 
of the contending armies. A war of invasion requires 
more preparation, foresight and forethought on the 
part of those who plan and conduct the campaign than, 
one of defense, a fact we have been painfully made 
aware of during the last two months. The more 
remote the seat of conflict, the more diflScult the task 
of providing food and clothing for the army, and the 
more serious becomes the problem of properly caring 
for the sick and wounded, and the greater becomes 
the diflBculty in returning the survivors to their homes. 
Nostalgia, a very common affection among unseasoned 
troops, becomes more prevalent in proportion to the 
distance between home and the seat of war, as we had 
abundant opportunities to observe during the late 
war. The depressing effect of this common ailment 
has a decided influence in increasing the rate of mor- 
tality of the sick and wounded, and in impairing the 
effectiveness of the fighting line. Nostalgia is a con^ 
tagious disease, not in the sense we use the word 
contagion ordinarily, but when once established in 
camp it increases rapidly by suggestion. The onset 
and spread of this common ailment of camp life are 
promoted by interruptions of the mail service, the only 
medium of communication between the soldier in the 
field and his distant home. Among the many sins of 



123 

omission of those in charge of the management of 
the late war was a glaring neglect to provide for the 
much-needed and anxiously looked for mail facilities. 
If those who have the management of this branch of 
the government service in charge could be made to 
understand what an occasional letter will do in keep- 
ing up the spirit of the citizen soldier, nostalgia 
would have been less prevalent and its effects less 
disastrous during the late campaign. From the time 
I left Fortress Monroe for Cuba, July 3, and until I 
arrived in New York from Porto Rico, August 19, I 
received only two letters of the probable two hundred 
sent to me during this time. In summing up the 
casualties of the war just ended, it is safe to make the 
statement that the number of killed and the number 
of deaths resulting from the immediate effects of 
wounds will not exceed 280. The number of wounded 
will in all probability reach 1425. The number of 
deaths from malaria, dysentery, yellow fever and 
typhoid can not be estimated at this time, as these 
diseases are still prevailing and will claim many 
victims before the troops are recalled. The loss 
of life and the suffering as well as disability, as a 
claim for pension, caused by disease and the effects 
of climate will exceed by far those caused by Spanish 
bullets. During the Porto Rican campaign no pitched 
battle was fought. The force of the enemy in all of 
the skirmishes was small and in ambush. Only a few 
were killed and not more than forty were wounded. 
Among the wounded, bone injuries were rare, many 
of the wounds slight. All of these cases tend to con- 
firm previous observations to the effect that the small 
caliber bullet of the Mauser rifle, the one used exclu- 
sively by the Spaniards, causes wounds of the soft 
parts, which if left alone under the first dressing, will 
heal by primary intention in the course of a week or 
two, unless complicated by serious visceral injuries. 
All of these cases corroborate the statement previously 
made that the small caliber bullet does not infect the 
wound and that it seldom carries with it into the tis- 



124 

sues clothing or other infectious substances. This 
observation, so abundantly supported by substantial 
facts, is an extremely important one for future field 
service, as it must satisfy the military surgeons that 
such wounds will heal promptly if left alone under 
the first-aid antiseptic dressing. On the other hand, 
_ I have seen the evil consequences following meddle- 
some surgery in the form of unnecessary probing. 
Such wounds are very susceptible to secondary infec- 
tion caused by the use of the probe. For the purpose 
cf again calling attention to the humane nature of the 
modern weapon, and with a view of showing how 
rapidly wounds inflicted with the small caliber bullet 
will heal under the most conservative treatment, I 
will report briefly the nature of the wounds and the 
results of those wounded in the Porto Rican war: 

Ca%e :/.— Lieut. J. C. Byron, Troop F, Eighth Cavalry, 
wounded in the skirmish near Mayaguez, August 10. The 
bullet passed through the foot from side to side on the dorsal 
aspect, making a groove on the upper surface of the second 
and third metatarsal bones without fracturing them. Healing 
by primary intention under the first dressing. He was in the 
saddle when injured. 

Case 2. — Lieut. John Haines, Battery F, Third Artillery, 
was wounded in the attack on Aibonito, August 13, and is 
probably the last man shot by the Spaniards during the inva- 
sion of Porto Rico. He was in the advance of the line, with 
his battery planted on a high hill in full view of the enemy. 
After firing the number of shots ordered, the gun was turned, 
and at this moment a bullet struck him in the left lumbar 
region, postaxillary line, and escaped about the sixth inter- 
costal space, anterior axillary line, on the same side. No 
indications of bone injury or penetration of the chest. The 
wounds were dressed in the field and healed by primary inten- 
tion. He was conveyed in an ambulance from the front to 
Ponce, a distance of twenty miles, and transferred to the hos- 
pital ship Relief. At no time has he suffered much from pain 
or even a sense of discomfort which could be referred to the 
wound. The patient must have been in a stooping position the 
moment the injury was received. 

Case 5.— Lieut. T. H. Hunter, Battery B, Fifth Artillery, 
was accidentally shot by one of his own men by a Krag Jorg- 
ensen bullet, which entered the right side of the ilium, passed 
downward and backward, emerging from the gluteal region on 
the same side below the ramus of the ischium. The course of 
the bullet excluded bone injury in this case. Notwithstand- 



125 

ing the length and depth of the tubular wound it healed 
rapidly by primary intention. The indications are that the 
patient will recover without any functional inapairment of the 
parts implicated in the injury. 

Case i.— William H. Walcutt, Company E, Fourth Ohio 
Infantry, was wounded in the skirmish near Guayamo, August 
8. The bullet entered the plantar surface of the left foot be- 
tween the first and second metatarsal bones, at the junction of 
the middle with the distal thirds, and escaped from the dorsal 
side, at a point a little nearer the distal side. From the course 
of the bullet it is clear that he was running in a direction op- 
posite to the enemy when the shot was fired. The wounds 
were healed a week after the injury was received. 

Case 5. — William J. Edgington, Company A, Fourth Ohio 
Infantry, was wounded during an engagement, August 8. The 
wound of entrance was at a point two inches to the left of the 
median line on a level with the sacrococcygeal joint, the 
wound of exit at the base of the opposite thigh over its inner 
and middle aspect, directly over the adductor muscles. No 
evidence of any serious visceral injury of any of the pelvic 
organs. The temperature remained normal, the wounds healed 
by primary intention, and when I examined the patient in the 
hospital at Guayamo, five days after the injury was inflicted, 
the patient was free from pain and able to leave his cot with- 
out assistance. The course of this bullet explains the posijbion 
of the patient at the time the bullet reached its unwilling, 
moving mark. 

Case (9. —Noble W. Horlocker, Company C, Fourth Ohio 
Infantry, was wounded in the same skirmish. The bullet en- 
tered one inch in front of the right malleolus and escaped two 
and three-fourth inches below and a little behind the external 
malleolus. Although the bullet must have passed through 
the ankle joint and the astragalus, the injury was followed by 
very little pain, except on moving the ankle joint, and no indi- 
cation of infection had set in five days after the injury was 
received. It is reasonable to expect that the wounds will heal 
by primary intention, and that the patient will recover with a 
useful, movable ankle joint. 

Case 7.— Stewart J. Mercer, Company E, Fourth Ohio 
Infantry, was wounded August 5, in a skirmish on the way 
from Arroya to Guayamo. The bullet made a fiesh wound 
over the inner margin of the left patella, and healed by pri- 
mary intention in a few days. 

Case 8.— Samuel T. Jones, Company C, Fourth Ohio In- 
fantry, received a wound above the right patella, August 8, 
Wounds of entrance and exit one inch apart. Primary heal- 
ing under the first dressing. 

Case 9. — Edward O. Thompson, Corporal Company K, Fourth 
Ohio Infantry, was wounded near Guayamo, August 8. The bul- 
let entered the forearm two- thirds of an inch above the wrist 



126 

joint, on radial side, and after passing through the soft tissue 
in front of the bones, emerged from the inner aspect of the 
forearm just above the wrist joint. Wound healed by primary 
intention under the first dressing. 

Case 10. — Harry Lee Haynes, Company C, Fourth Ohio 
Infantry, was lying down in a ditch at the time he was 
wounded, August 8. The bullet struck the arm two inches 
above the insertion of the deltoid muscle and emerged over 
the sternoclavicular articulation on the same side. A third 
wound was found on a line with the course of the emerging 
bullet one inch below the mastoid process and in the direction 
of the sterno cleido-mastoid muscle. A fourth wound, an 
inch and a half in length, one quarter of an inch in depth and 
an inch in width, was found on the dorsum of the right fore- 
arm an inch above the elbow joint. All the wounds healed 
rapidly, caused but little suffering, and the patient was in a 
fair way to recovery when seen a few days after he was 
wounded. 

Case ii.— Clarence W. Riffer, Company A, Fourth Ohio In- 
fantry, was wounded August 8. The bullet entered the right 
thigh at a point five inches above the knee joint and about the 
middle of the external surface, passed through the soft tissues 
making its exit three inches to the left of the point of entrance. 
It re-entered the left thigh at a point two and a half inches 
above the knee joint, and an inch and a-half to the right of the 
posterior median line and emerged on the oposite side an inch 
and a-half above the knee joint. Both fiesh wounds deep and 
long as they were healed primarily without suppuration. 

Case 12. — John O. Cordner, Company C, Fourth Ohio In- 
fantry, was wounded August 5. The bullet made a flesh 
wound at the lower border of the patella, the wounds of en- 
trance and exit being separated by a space an inch and a half 
in length. Primary healing under first dressing. 

Case i5.— William Rossiter, Company G, Eleventh U. S. In- 
fantry, was wounded in the skirmish near Mayaguez, August 
10. He was shot through the inferior maxilla. The bullet 
entered just below the margin of the bone on the right side 
about an inch in front of the angle and emerged over the angle 
of the bone on the opposite side, perforating the soft tissues of 
the neck in a transverse direction. The bullet appears to have 
passed through the bone without fracturing it. The only pain 
the patient complains of is produced when he undertakes to 
masticate food. Wounds of entrance and exit healed in a few 
days by primary intention. 

Case ii.— Amos Wilkie, Eleventh U. S. Infantry, was on the 
march when wounded near Mayaguez, August 10. The bullet 
entered the right lumbar region just above the crest of the 
ilium, mid axillary line, and emerged about two inches to the 
left of the spine and four inches above the left sacro-iliac syn- 
chondrosis. No indications of intra-abdominal complications. 



127 

He suffered considerable from cramping pains, which he attri- 
butes to cold and fever which he contracted by exposure to 
rain. A week after the injury was received, when the patient 
was an inmate of the Hospital Ship Relief, his condition war- 
ranted the hope of an early and complete recovery. 

Case 15. — Harry C. Errick, Company C, Eleventh U. S. In- 
fantry, was wounded August 10, in a charge on the enemy in 
ambush. Wound of entrance in left leg over the outer aspect 
of the middle third ; the bullet passed downward and inward 
and emerged about five inches above the inner malleolus. 
Hemorrhage slight, no fracture. Wound healing rapidly under 
first dressing. 

Case J?^.— William H. Wheeler, Company A, Eleventh U. S. 
Infantry, was wounded August 10, near Mayaguez, when in a 
standing position with his side in the direction of the enemy, 
his gun down, ready to reload. The bullet struck the tenth 
intercostal space, left side, in the post axillary line and made 
its exit about four inches from the spine in the lumbar region 
close to the margin of the last rib. No serious complications 
followed the injury, and at the present time, August 14, the 
patient is improving rapidly. 

Case 11. — George Curtis, Company D, Light Battery, Fifth 
Artillery, received a wound of the chest August 10, being in his 
saddle at the time. The bullet passed through the chest from 
the second left intercostal space in front to the middle of the 
outer border of the scapula on the same side. No hemoptysis 
or any other serious symptoms indicating the existence of the 
visceral wound of the lung. The only thing he complains of is 
a sense of numbness in the left arm. Primary union of both 
wounds. 

Case 18. — Joseph P. Ryan, Corporal Company A, Eleventh 
U. S. Infantry, was wounded August 10. The bullet passed 
through the ankle joint. Wound of entrance over the internal 
malleolus of left leg, wound of exit two inches below the outer 
malleolus. No infection or signs of synovitis. Wounds heal- 
ing by primary intention. 

Case 19. — Samuel Copp, Company A, Eleventh U. S. In- 
fantry, received a scalp wound, August 10, while he was lying 
on his abdomen on the summit of a hill. Wounds of entrance 
and exit about two inches apart, healed under the first dressing. 
He is suffering from a contusion of his abdomen he sustained 
by falling over an embankment during the same skirmish. 

Case 20. — Arthur Sparks, Company C, Eleventh U. S. In- 
fantry, received a wound of the lower third of the left thigh, 
August 10. Wound of entrance on external anterior aspect of 
thigh about five inches above patella. The bullet passed 
directly backward and came out on the opposite side on the 
same level without injuring the femur. Healing by primary 
intention. 

Case 21. — George W. Whitlock, Company C, Sixteenth Penn- 



128 

sylvania Infantry, was in a kneeling position when wounded 
near Guayamo, August 9. The bullet entered the thigh near 
the perineum, over the adductor magnus muscle, passed in 
an outward and backward course and emerged from the gluteal 
region near or over the sciatic foramen. Hemorrhage slight. 
Paralysis of the foot and lower part of the leg points to injury 
of the sciatic nerve. Healing of wound without complications. 

Case 22. — James Drummond, Company K, Sixteenth Massa- 
chusetts Infantry, was wounded near Guayamo, August 9. 
The bullet entered the neck on the leftside, behind the sterno- 
cleido- mastoid muscle, two inches below the mastoid process. 
Wound of exit on the opposite side in front of the trapezius 
muscle. No immediate or remote complications. Wound healed 
by primary intention. Patient has suiffered from slight attack 
of malarial fever. 

Case ^5.— Paul J. Mytzkie, Company D, Eleventh U. S. 
Infantry, was wounded in the skirmish near Mayaguez, August 
10. The bullet made a flesh wound three inches above the 
external malleolus, which healed in a few days by primary 
intention under the first dressing. 

Case 24:. — Daniel J. Graves, Company M, Eleventh U. S. 
Infantry, received a gunshot wound of the thigh near Maya- 
guez, August 10. The bullet passed through the thigh in an 
antero posterior direction, fracturing the femur at the junction 
of the middle with the lower third. A week after the injury 
the patient was in excellent condition, the wounds remaining 
aseptic and healing rapidly. 

Case 2b. — Theodore H. Newbold, Company I, Sixteenth 
Pennsylvania Infantry, was shot while retreating during the 
skirmish near Guayamo, August 9. The bullet entered the 
right arm above the olecranon process and emerged from the 
extensor side of the forearm between the radius and the ulna. 
The olecranon process was broken off. The X-ray reveals the 
presence of a fragment of the bullet, or its mantel, lodged in 
the wound. Aseptic healing of the wound. 

Case .^(?.— Clyde C. Frank, Company C, Sixteenth Pennsyl- 
vania Infantry, was injured near Guayamo, August 9. The 
bullet entered the inner surface of the middle of the right 
thigh, passed upward and backward, and in grazing the femur 
made a groove without fracturing the bone, emerging from the 
external and posterior aspect of the thigh. Both wounds 
healed by primary intention. In making a skiagraphic examin- 
ation of the seat of injury a fragment of the bullet was dis- 
covered in the groove. The piece of lead, as well as a few loose 
fragments of bone, were removed August 17 by enlarging the 
wounds of entrance and exit. Operation by Dr. Shultze. 

Case ^7.— John L. Johnson, Company D, Eleventh U, S. 
Infantry, received a gunshot injury near Mayaguez, August 10. 
The bullet passed in an antero posterior direction through the 
middle third of the left leg, going through the space between 



129 

the tibia and fibula. Hemorrhage slight. Healing by primary 
intention. 

Case 28. — Samuel G. Frye, Company D, Fifth Artillery, was 
injured by a deflected bullet, as he stood by his cannon, near 
Mayaguez, August 10. The bullet passed through the soft 
tissues in the right anterior axillary fold without doing any 
further damage. The wound healed by primary intention. 

Case 29. — Henry Gerrick, Company E, Eleventh U. S. Infan- 
try, received a superficial wound over the pronator muscles, 
near Mayaguez, August 10. The wound healed promptly by 
granulation. 

Case 50.— John Browning, Corporal, Battery D, Fifth Artil- 
lery, was wounded near Mayaguez, August 10. The bullet 
passed transversely through the soft tissues of the right fore- 
arm on a level with the wrist, in front of the radius and ulna. 
The bullet evidently cut the ulnar nerve and vein, as shown by 
the paralysis of the parts supplied by the nerve below the seat 
of the wound and the free venous hemorrhage which immedi- 
ately followed the injury. Healing by primary intention. 

The marked contrast in the results of the treatment 
of the wounded in Cuba and Porto Rico, I attribute 
entirely to the better preparations made for the last 
invasion, and not to any diflference in the surgical 
skill of the medical officers. The surgeons engaged 
in the Cuban war were men exceptionally well pre- 
pared for their profession, and performed their oner- 
ous task with energy and enthusiasm. Ambulances 
were scarce, the fighting line far away from the base 
hospital, conditions which made it difficult to render 
timely and efficient first aid. Another circumstance 
which had its influence in interfering with the prompt 
and effective first aid to the wounded in Cuba was 
the large number of men who fell in battle in three 
days. The war in Cuba precipitated in a pitched 
battle; in Porto Rico it consisted in a number of skir- 
mishes in which only a small number needed surgical 
attention. In Porto Rico the rear of the different 
armies was supplied with an adequate number of 
ambulances and Hospital Corps men. The first aid 
was rendered almost immediately after the wounds 
were received, after which the patients were conveyed 
to the hospital* at once. A sufficient number of med- 
ical officers were on hand during each engagement to 



130 

take immediate and proper care of the wounded. In 
most instances the wounds healed by primary inten- 
tion under the first dressing. The value and impor- 
tance of early surgical attention, and the first-aid 
dressing, became apparent in comparing the condition 
of the wounds, a week after the injuries were received, 
during the Cuban and Porto Rican campaigns. 



ON THE FREQUENCY OF CRYPTORCHISM AND 
ITS RESULTS. 



Cryptorchism and incomplete descent of the testicle are 
congenital defects, the frequency of which has never been 
established by reliable and extensive statistics. Undescended 
testicle, partial and complete, is frequently seen in infants 
and children, but becomes more rare with the development of 
the body to manhood. The writer has recently had an oppor- 
tunity to make an accurate investigation into this subject by 
the examination of 9815 recruits for the Volunteer Service at 
Camp Tanner, Springfield, 111. The ages of the men varied 
from 16 to 51. The following is the result of the examination 
with reference to the incomplete descent of the testicle : 

Cryptorchism, — Right side, 12; leftside, 22; both sides, 1. 

Incomplete descent of testicle. — Right side, 10 ; with hernia, 
1 ; left side, 14. 

Total number of incomplete descent of the testicle in 9815 
men, 59. Unilateral incomplete descent, the left side was 
affected 36 times, the right side 22. Out of 59 cases the 
defect was bilateral only once. In this case the inguinal canals 
were found completely obliterated, no trace of the testicle 
could be found. The man was in excellent health, married and 
father of several children. In only two instances was the 
incomplete descent of the organ complicated by a small hernia, 
in both cases on the right side. Both of these men were 
rejected. In all cases in which the testicle could be palpated 
the organ was found atrophic, seldom exceeding the size of a 
filbert or pigeon's egg, soft and not tender to touch. The 
testicles were most frequently found just within or below the 
external inguinal ring ; in the latter location it could be freely 
moved in all directions without causing any pain. None of the 
men thus afflicted complained of pain or even discomfort 
caused by the imperfectly developed and incompletely de- 
scended testicle. Recent scientific investigations appear to 



132 



establish the fact that cryptorchism and incomplete descent of 
the testicle are attributed rather to an imperfect development 
of the organ than to a failure to reach its normal destination 
at the right time. The results of these researches as well as 
the deductions to be drawn from statistic material utilized in 
this paper seem to combine in teaching surgeons caution in 
undertaking early operations for cryptorchism for the purpose 
of transplanting the organ into its normal position and with a 
view of maintaining or increasing its functional activity. The 
congenital hernia which so constantly attends retarded descent 
of the testicle frequently disappears in the course of time 
without operative or truss pressure. 
Chickamauga, June 25, 1898. 



THE SEAT OF WAR AND OUR MILITARY 
SURGEONS. 



At the time I am writing this communication I am at Fort- 
ress Monroe awaiting the arrival of the battleship Yale from 
Santiago de Cuba. Waiting is always tiresome, tedious, and 
often painful, but when it comes to waiting for a ship to take 
you to the seat of war, it is distressing. It has been the dream 
of my youth to take an active part in some great war, and now 
that I am in one, the very thought that I might not get near 
the fighting line is a source of keen disappointment. I have 
been in hopes that I would be present during the siege of San- 
tiago de Cuba, but according to the messages that are being 
flashed (July 2) from the seat of war to the department in 
Washington, the stars and stripes will float over the doomed 
city in less than twenty-four hours. The Yale is expected to- 
day, but it will take at least two or three days for the troops 
to embark. 

Our victories on land and sea will teach the crumbling mon- 
archies of the old world that the American people are not 
only foremost in agriculture, commerce and the different in- 
dustries, but that when forced to fight they know how to con- 
duct a war. The heroic deeds of the American soldier have never 
been appreciated, except by those who were the means of giv- 
ing him an opportunity of demonstrating his military quali- 
ties. England, Mexico and the native Indians, have been 
made to feel and are satisfied what the American soldiery can 
do. The proud Spaniards will be humuiliated in the eyes of 
the world as never before, and will soon plead for mercy and 
raise the white flag to negotiate for peace on any terms. Our 
people are now giving the world an object lesson in warfare 
that will not surely be forgotten. The military spirit is epi- 
demic in our country ; kindle it and it spreads like a flash of 
lightning, from North to South and East to West. We have 
the men, the muscle and the brains to bring into the field, at 



134 

short notice, the best army in the world. Only sixty-five days 
have elapsed since the Chief Executive of the United States 
issued the first call for troops, and at the present time a fairly 
well equipped army of 200,000 men are in the field, eager and 
anxious to face the enemy. Our navy, the laughing-stock of 
haughty foreign countries, has grown with an astounding 
rapidity, and its achievements have already challenged the 
admiration of the world, and have become a source of pride to 
every loyal American citizen. Statesman and politicians may 
differ in their views regarding the propriety and advisability 
of extending our possessions beyond the present limits, but 
one thing remains sure, that our country — perhaps, less as mat- 
ter of choice than of necessity — is destined to take an active 
part in the drama of international politics. The annexation 
of Hawaii and the present war with Spain — the latter provoked 
upon the most unselfish and purely humanitarian motives- 
have furnished the entering wedge into the field of foreign 
politics. Cuba should and must be owned by the United 
States. Cuba is the hot-bed, the breeding station of yellow 
fever, and always will remain so, whether under Spanish or 
Cuban rule. Yellow fever can be stamped out forever in less 
than two years after it has come into our possession. Yellow 
fever, always imported from Cuba, has retarded the prosperity 
of the South, and has ruined, at different times, the commerce 
of many of its otherwise flourishing cities, and has claimed 
the lives of more of our people than will be sacrificed in wip- 
ing out Spanish rule. Geographically and commercially, Cuba 
belongs to the United States. Cuban government would be 
only a repetition of what has always been going on in the 
neighboring islands and the republics of Central America — 
misrule and revolution. We want no such neighbors. Cuba 
must be freed from the Spanish yoke. The Cubans are not in 
a condition to establish and maintain a wise and prosperous 
self-government. Any such attempt would be little or no im- 
provement over Spanish rule, either to its population or the 
people of the United States. The natural resources of the 
island are great, and are only awaiting a stable government 
for their development. The scourge of yellow fever, always a 
menace to the life and commerce of our people, more especially 
of the Southern States, must be quickly and permanently re- 



135 



moved by eflPective sanitary measures, which can only be effi- 
ciently carried into effect by placing the island under the con- 
trol of the government of the United States. 

OUR MILITARY SURGEONS, 

The medical profession of all countries has always been 
intensely patriotic in times of war. The doctors always have 
been and always will be the salt of the population. Their 
education and training are of a nature to ensure qualities 
necessary to citizenship of the highest type. The practice of 
their profession, even in times of peace, is admirably adapted 
to prepare them for the emergencies of war. In the exercise of 
their duties they encounter hardships and dangers foreign to 
the lives of the average citizens. They face epidemics far 
worse than bullets, as far as danger to life is concerned, with- 
out fear of death. In cities devastated by the scourge of 
yellow fever or cholera, when everybody else that can leaves 
for a place of safety, the doctors remain at their posts and 
minister to the sick and dying without any expectation of a 
substantial financial reward, or even the gratitude of the 
recipients of their services. As the number of their well-to-do 
legitimate clients diminishes during the inevitable exodus their 
attention to the poor remains unremitting. Day after day and 
night after night the familiar modest conveyance with its 
lonely occupant can be seen in the depopulated streets, wend- 
ing its way to the hovels of the poor on its errands of mercy. 
The unselfish work of the doctor has never been properly 
appreciated. From the most ancient times, when battles were 
fought hand to hand with the most primitive weapons, medical 
men were on hand ready to dress the wounded and to heal the 
sick. None of them have ever attained the fame of the innu- 
merable heroes who distinguished themselves on the battle- 
field and whose deeds have been immortalized in prose and 
poetry. In rank, pay and social position the military surgeon 
has always been at a disadvantage as compared with the lead- 
ers of troops. The one that knows how to kill and mutilate 
has reaped more credit for his work than the one bent on his 
sole mission to prevent and treat disease and to heal wounds. 
Fame, influence and public recognition are within easy reach 
of the successful military commander ; they need not be looked 



136 

for, much less expected, by the hard-working, faithful, skilful 
surgeoD. His greatest reward, in military or civil practice, 
always has been and always will be the consciousness of having 
performed his duty to his fellow-men. 

During the present war with Spain the medical profession 
has responded promptly and nobly to the call of the country. 
The medical officers now in the field can be classified as fol- 
lows : Surgeons and assistant-surgeons United States Army ; 
surgeons and assistant surgeons United States Navy; sur- 
geons and assistant- surgeons of Volunteers; acting assistant- 
surgeons United States Army : acting assistant-surgeons of 
United States Navy. The surgeons of the army and navy, 
after a long, comparative rest, have now found an opportunity 
to make good use of their special training. Many of these 
men have taken a course in the Army Medical School and 
most of them have enjoyed excellent clinical opportunities 
in the large cities. Surgeon-General Sternberg has taken 
special pains to stimulate the younger members of his 
department to improve themselves by stationing them for 
a year in medical centers, where they had an opportunity 
to attend lectures and clinics and to do laboratory work. The 
advantages of instruction of this kind will become obvious 
in this war. The professional military surgeon is well versed 
in the executive part of his duties, which is sadly lacking in 
the less favored volunteer surgeon. To the praise of the former 
it must be said that he is always ready to impart knowledge of 
this kind to his colleague from civil life. The volunteer sur- 
geon represents that portion of the young men of our profession 
who possess not only a full measure of patriotism, but also a 
laudable degree of surgery and enthusiasm. Many of them 
now in the field have left a lucracive practice, and are now 
giving their services to the country for an insignificant salary. 
Many of our volunteer surgeons have had hospital experience 
either as internes or attending physicians, or both. Their prac- 
tical experience has been such as to prepare them well for their 
work in the field. Without exception all are anxious to go to 
the front to assume the hardships of active military life. They 
are anxious and ready to learn and work. The only complaints 
I have heard were about the monotony and nothing-to-do of 
camp life. Every one that goes to the front is envied by those 



137 

left behind. They have left their homes, their families, their 
practice, to sacrifice themselves, if need be, for the good cause. 
I am sure when the Medical and Surgical History of the Amer- 
ican Spanish War is written it will be brim full of the good 
work done by the volunteer surgeons. It will record at the 
same time many deeds of bravery and heroism on their part. 
The acting assistant-surgeons, both in the Army and the Navy, 
are so-called contract surgeons. They are appointed, without 
examination, by the respective Surgeon-Generals, for the dura- 
tion of the war, and are given the rank and pay of a first lieu- 
tenant. They are mostly bright young men, recently from col- 
lege or hospital, who will do their good share in preventing 
disease and in relieving the sufferings of the sick and wounded. 
The Association of Military Surgeons of the United States has 
done the most during its short existence of eight years in es- 
tablishing the most friendly relations between the professional 
and civilian military surgeons, and in preparing the medical 
service for war. The interest in this association will be greatly 
enhanced by the present war, and the first meeting after the 
close of hostilities will be a large and enthusiastic one. 

As I write, an order reaches me from Washington instruct- 
ing me to be in readiness to leave this evening or tomorrow 
morning on the hospital ship Relief, which calls here on its 
way from New York to Santiago. Acting Assistant- Surgeon, 
Henry S. Greenleaf, son of the Chief Surgeon of the Army in 
the field, accompanies me, and will be associated with me in 
my future work. 

Fortress Monroe, July 2, 1898. 



Headquarters Pieth Army Corps, 
Before Santiago, July 12, 1898. 

As the hospital ship Relief came in sight of the seat of war 
every one of its passengers watched with interest and anxiety 
the indications of the present status of the conflict. When we 
sailed from Fortress Monroe, Sunday, July 3, fighting was in 
progress, and not having received information of any kind 
since that time we were impatient for news. On reaching 
Guantanamo we came insight of a number of warships floating 
lazily on the placid ocean, like silent sentinels, some six to 
eight miles from the shore. The little bay was crowded with 
empty transports, all of which indicated that we were not as 
yet in possession of Santiago. The pilot of a patrol boat finally, 
in a voice like that of a fog horn, communicated to us the news 
that the greater part of the Spanish fleet had been destroyed 
and that the Spanish loss in dead, wounded and prisoners was 
great. Among the most important prizes of the naval battle 
was the heroic admiral of the Spanish fleet, who was then a 
prisoner on board of one of the men-of-war. The land forces 
were near the city making preparations for the final attack. 
A partial, if not a complete victory had been won, and we had 
the satisfaction of knowing that we had not come in vain. Our 
captain was directed to bring his ship to anchor near Siboney. 
When we came in sight of this little mining town we saw on 
shore rows of tents, over which floated the red cross flag, show- 
ing us that we had reached the place for which we had been 
intended. The little engine of a narrow-gauge mining railroad 
was puffing and screeching up and down along the coast con- 
veying supplies from the landing to the camp. On the side of 
a hill were the shelter tents of a company of infantry on detail 
for guard duty. On the crest of a number of high hills which 
fringe the coast could be seen block-houses recently vacated 
by the Spaniards. A grove of palm trees in a near valley re- 
minded us that we had reached the tropical climate. The 



139 

steamer Olivette, floatiDg the Red Cross, was anchored near the 
shore. Major Appel, surgeon in charge of this hospital ship 
was the first person to board our vessel, and gave us the first 
reliable account of the recent battle. His appearance was 
enough to give us an insight into his experience of the last few 
days. He was worn out by hard work and his anxiety for the 
many wounded under his charge. He spoke in the most flat- 
tering terms of the services of Acting Assistant-Surgeon 
Parker of New Orleans. Owing to the depth of the ocean, it 
was impossible to find anchorage for the Relief on the first day. 
The sea was quite rough and it was under difficulties that 
Majors Torney, Appel and the writer were landed on July 7. 
The first person I met on landing was Major Xancrede, pro- 
fessor of surgery in the University of Michigan, He reached 
Cuba at the right time to give his valuable services to his 
country. Hundreds of wounded had received the benefit of 
his skill. Slight in figure, and anything but robust, he per- 
sisted in working night and day, until he was worn out by 
fatigue and loss of sleep. I found him under a fly-tent, resting 
on the hot sand. He was making preparations for an early 
departure, in charge of 301 wounded, on the transport ship 
City of Washington. The country, and especially those who 
received his careful attention, owe a debt of gratitude to Major 
Xancrede that can never be paid. 

On reaching the camp I met my friend of years ago, Major 
LaGarde, U. S. A., in charge of the hospital at Siboney, which 
had been made the base of operations of the troops in the field. 
It would have been difficult indeed to find a better man for 
this trying and responsible position. By nature and training 
a perfect gentleman, learned in his profession and experienced 
in warfare, he was in possession of all the qualities required of 
a medical officer in charge of such an important post. The 
difficulties he encountered often appeared insurmountable, but 
were met successfully by his cool and mature judgment and 
promptness of action. His kind but dignified conduct com- 
manded the respect of his subordinates, who were only too 
willing to carry out his orders. Considering the limited sup- 
plies within his reach, and the many urgent demands for them 
from all sides, it is a source" of astonishment that so much was 
accomplished in so short a time. Inadequate preparations had 



140 

been made for casualties on such a large scale, but he made 
the best of the limited resources and used them where most 
needed, often regardless of prescribed military channels. In 
less than four days nearly 1000 wounded soldiers sought the 
shelter of his tents. During this trying time he worked inces- 
santly, regardless of his own health and personal comforts. 
When the roll of honor is made out at the close of the war, the 
name of Major LaGarde deserves a well-merited place at the 
head of the list. In his arduous duties he was ably assisted 
by Major McCreary and Captains Ireland and Fountleroy of 
the United States Army, and a corps of acting assistant sur- 
geons. The camp is on the shore, on a limited plateau at the 
base of the mountain rising behind the little mining village. 
The condition of the wounded men furnished satisfactory 
proof that good work had been done here, as well as at the 
front. On my arrival many of the wounded had already been 
placed on board a transport ship, but more than 400 remained 
in the general hospital. On the whole, the treatment to which 
the wounded men were subjected was characterized by con- 
servatism. Only a very small number of primary amputations 
were performed. Bullets that were found lodged in the body 
were allowed to remain undisturbed, unless they could be 
removed readily and without additional risk. A number of 
cases of penetrating wounds of the abdomen and chest were 
doing well without operative interference. Penetrating gun- 
shot wounds of the skull were treated by enlarging the wound 
of entrance, removal of detatched fragments of bone, and 
drainage. Several cases in which a bullet passed through the 
skull, injuring only the surface of the brain, were doing well. 
With few exceptions, wounds of the large joints were in a fair 
way to recovery under the most conservative treatment. 

A study of the immense amount of material collected at this 
station satisfied the surgeons that the explosive effect of the 
small caliber bullet has been greatly overestimated. The sub- 
sequent employment of the X-ray in many of these cases will 
undoubtedly confirm the results of these observations. The 
battle of Santiago resulted in 157 killed and 1300 wounded. 
Nearly all wounds of the soft parts healed rapidly. Suppur- 
ation in these cases was the exception, primary healing the rule. 
The deceptive nature of wounds of the soft parts is best shown 



141 

by a case of gunshot injury of the knee-joint that came under 
my care during the first afternoon. The knee-joint was dis- 
tended to its utmost, painful and tender on pressure. A rise 
in temperature and corresponding general disturbances indi- 
cated the existence of infection. A small opening was found 
over the inner border of the patella on a level with the articu- 
lations. A careful search for the wound of exit proved negative. 
During the preparation of the limb for the operation another 
effort was made to find a second wound with the same result. 
After the patient was under the influence of the anesthetic 
the limb was rendered bloodless by elastic constriction made 
at its base. The knee-joint was opened freely by an incision 
in line with the wound of entrance. A large quantity of liquid 
blood escaped. A furrow on the surface of the internal condyle 
of the femur led to a deep groove in the under surface of the 
patella, and taking these as a guide the wound of exit was 
finally discovered with the groove directly over the inner 
surface of the knee-joint in the form of a small slit. Through 
this slit-like opening a probe was inserted and advanced into 
the grooves in a straight line without any difficulty. There 
could remain no further doubt as to the existence of a wound 
of exit. The joint contained a large quantity of blood, but 
no detached fragments of bone. The joint was washed out 
with a 2 per cent, solution of carbolic acid, the capsule sewed 
with catgut and the external wounds with silk and, after 
dressing, the limb was immobilized by the use of a posterior 
splint, made of the sheath of the palm leaf. The patient was 
doing well when sent home on a transport, two days later. 

AFTER THE BATTLE. 

The day after my arrival I went to the front, about ten miles 
from Siboney. A colored orderly was my only companion ; he 
rode at a respectful distance to the rear. The whole distance 
the road was crowded with mule teams, soldiers and refugees. 
The refugees made up a seething mass of humanity from start 
to finish. At a low estimate, I must have passed on that day 
two thousand souls, including men, women, children and naked 
infants. The day was hot, and the suffering of the fleeing 
inhabitants of Santiago, the besieged city, and adjacent villages 
can be better imagined than described. Indian fashion, the 
women walked while some of the men enjoyed the pleasure of 



142 

a mule- or donkey-ride. Most of them were barefoot and dressed 
in rags ; children and infants naked. Dudes with high collar, 
white necktie and straw hat were few and far between. An 
occasional old umbrella and a well-worn, recently- washed white 
dress marked the ladies of distinction. Their earthly posses- 
sions usually consisted of a small bundle carried on the heads of 
the women, or a worn-out basket meagerly loaded with mangoes 
or cocoanuts. The color of the skin of the passing crowd pre- 
sented many tints, from white to jet-black. The women were 
noted for their ugliness, the men for their eagerness to get be- 
yond the reach of guns. Little squads of Cuban soldiers were 
encountered from time to time, apparently anxious to get only 
as far as the rear of our advancing army. These men display 
an appearance of courage just now that is something mar- 
vellous. Before the blue coats came here they infested the 
inaccessible jungles at a safe distance from the Spanish guns, 
making an occasional midnight raid to keep the Spaniards on 
the lookout ; now they can be seen on the roads in small groups 
relating to each other how they cut down the Spanish marines 
with their national weapon on reaching the shore after their 
vessels were demolished by our navy. The ragged refugees, 
fleeing in all directions and mingling freely with our troops, as 
they do, carry with them the filth of many generations and a 
rich supply of yellow fever germs, which will ultimately kill 
more of our men than the Spanish soldiers. On the way to 
the front Chicago push and enterprise came in evidence by the 
appearance of a mule of the smallest species carrying a rider 
all out of proportion in size to the diminutive animal. Sus- 
pended from the neck and dangling over the breast of the 
animal, was a piece of pasteboard on which was inscribed, 
"T/ie Chicago Record.''^ To my question, "How is the Chicago 
Record 9'*' the rider answered, "All sold out." On reaching 
General Shafter's headquarters, I reported to Lieut. -Colonel 
Pope, Chief Surgeon of the Fifth Army Corps. Colonel Pope 
has worked night and day since the troops landed here. He 
has done all in his power to make his limited supplies meet the 
enormous demands. At headquarters is the principal field 
hospital, in charge of Major Wood, a graduate of Rush Medical 
College, ably assisted by Major Johnson and a corps of acting 
assistant-surgeons. At the time of my arrival, 68 wounded 



143 

officers and men were under treatment at this hospital. Major 
Wood kindly invited me to perform an amputation of the thigh, 
for gangrene caused by a gunshot injury, which had fractured 
the lower portion of the femur and cut the popliteal artery. 
The wound of entrance was over the inner margin of the 
patella and that of exit over the lower and outer aspect of the 
thigh. The knee-joint and thigh were enormously swollen and 
the gangrene had extended to within a few inches of the knee- 
joint. The pulse was rapid and the temperature over 105 
degrees F. The amputation was made at the seat of fracture, 
above the condyles of the femur, by making a long oval anterior 
and a short oval posterior flap. The vessel was tied above the 
seat of injury. NotwithstandiDg the extensive edema of the 
tissues, the wound was in excellent condition three days later, 
and the temperature normal. Here I found many interesting 
cases on the way to recovery in which the nature of the injury 
would have been ample excuse for rendering a very grave prog- 
nosis — among them a number of cases of penetrating wounds 
of the chest and abdomen. Four laparotomies for gunshot 
wounds were made here by a volunteer surgeon, but as all the 
patients died it was deemed expedient to assign him for duty 
at a place where he could do more good than harm. 

IN THE CAMP OF THE ENEMY. 

In the afternoon I accompanied Acting Assistant-Sur- 
geon Goodfellow to El Caney. The trip was made for the 
purpose of taking charge of sixteen wounded Spaniards we 
were to transfer to the Spanish Army. On the way to El Caney 
we found many recent graves and numerous dead horses cov- 
ered only with a few inches of dirt. The stench from this 
source in some places was almost unbearable. The little 
village of El Caney is located on the summit of a hill with an old 
dilapidated church for its center. The public square and the 
few streets were thronged with refugees, from 8000 to 10,000 
in number. Crowds of refugees were also seen in the woods 
around this village gathering mangoes and cocoanuts, about 
the only food supply at this time. In the vestry room of the 
church we found a representative of the Red Cross Associa- 
tion dealing out hardtack and flour to the hungry multitude. 
The wounded Spaniards were lying in a row on the floor of the 
church, one of them in a dying condition. All that could be 



144 

transported were conveyed in four ambulances under a small 
detachment of troops to our fighting line. Here a flag of 
truce was received, which was carried by an orderly, the 
detachment was left behind and we passed our line. As soon 
as the Spanish intrenchments came in sight the signal was 
given and was promptly answered by the enemy. Two officers 
with a flag of truce advanced toward us and we were halted at 
a little bridge very near Santiago and below the first intrench- 
ment. We were received very courteously by the officers and 
asked to a seat upon the grass in the shade of a clump of 
trees. Rum, beer and cigarettes were furnished for the enter- 
tainment of the callers. The object of the visit was explained, 
whereupon a hospital corps of about thirty men with sixteen 
litters, in charge of a captain of the line and a medical officer, 
made their appearance. The wounded men were unloaded 
from the ambulances and conveyed on litters to within the 
Spanish line. The visit was such a cordial and pleasant one 
that we found it very difficult to part from our newly made 
friends. After bidding the officers a hearty adieu and mount- 
ing my horse, I was urged to dismount and say another fare- 
well, a request which was responded to with pleasure. The 
two little parties then separated and made their way in a slow 
and dignified manner in the direction of the respective breast- 
works. 

ARTILLERY ATTACK. 

The first armistice expired at noon, July 11. In the after- 
noon a heavy cannonading commenced and was kept up until 
late in the evening. Next morning it was resumed, however 
with less vigor. During this bombardment the Spaniards 
renewed their recently gained reputation as effective marks- 
men. One of our best cannons was hit and literally lifted into 
the air. An officer was killed and a number of men injured. 
During the afternoon, while cannonading was still going on, 
I went to the front, but on reaching our line bombardment 
was discontinued, and under a flag of truce the commanding 
generals met and held a conference. The result of this inter- 
view remains a secret to this hour. 

GENERAL MILES ARRIVES. 

Major-General Miles and staff reached Siboney, yesterday, 
on the steamer Yale and today he proceeded to headquarters. 



145 

The appearance of yellow fever at different places occupied by 
our army has made our troops more anxious than ever to com- 
plete their task. The frequent drenching rains and inadequate 
equipments have also done much to render the men restless 
and anxious to fight. 



KECENT EXPERIENCES IN MILITARY SURGERY 
AFTER THE BATTLE OP SANTIAGO. 



On Board the Hospital Ship "Relief," 
July 22, 1898. 
wound infections. 

Military surgery is no more no less than emergency surgery 
in civil practice. The surgeon in daily practice has learned 
long ago that every accidental wound must practically be 
regarded and treated as an infected wound. In this respect 
the military surgeon of today has the advantage over his col- 
league in civil practice in knowing that the small caliber bullet 
inflicts wounds which per se are more often aseptic than sep- 
tic. Our recent experience in Cuba has shown that the small 
jacketed bullet seldom carries with it into the tisssues clothing 
or any other infectious substances. Most of the wounds of 
the soft tissues, uncomplicated by visceral lesions, which 
in themselves would become a source of infection, healed by 
primary intention in a remarkably short time. If infection 
followed it usually did so in the superficial portion of the 
wound in connection with the skin, and what is more than sug- 
gestive, the wound of exit was more frequently affected than 
the wound of entrance. This can be readily explained from 
the larger size of the wound and more extensive laceration 
and tearing of the tissues. In many of the cases ideal healing 
of the wound did not occur, owing to a subsequent limited 
superficial suppuration of the wound. The deep tissues were 
seldom implicated in such cases. I have reason to believe that 
some of the compound fractures which are now suppurating 
had such a source of infection, that is the extension of a super- 
ficial infection to the seat of fracture. Two weeks have now 
elapsed since the battle of Santiago was fought and we are 
now in a position to inquire more critically into the manner in 
which the wounds became infected. The many failures in 
protecting the more serious wounds against infection are at- 
tributable to three principal causes : 1. Inadequate supply of 



147 

first dressing, 2. Faulty application of first dressing. 3. Un- 
necessary change of dressing. The medical officers with the 
regiments and in the field hospitals were hampered in their 
work by an insufiiciency of proper material. The rapidity with 
which the invasion was planned and executed, the difficulties 
encountered in transporting the hospital supplies to the front 
and the unexpected large number of wounded readily explain 
the lack of dressing material when it was most needed. 
Many of the dressings were too small and not sufficiently 
secured to keep them in place in transporting the wounded 
from the front to the field hospitals. As a rule not enough 
attention was paid to the immobilization of the injured 
part, an important element in securing rest for the wound and 
in guarding against displacement of the dressings. It is a source 
of regret that plaster-of-Paris dressings were not more fre- 
quently employed in the treatment of gunshot fractures of the 
extremities. Another very palpable evil in causing infection 
was the too common practice of unnecessary change of dress- 
ing. The transfer of patients from one surgeon to another 
could not be avoided. Patients brought from the first dressing 
station to the Field Hospital usually were subjected to a change 
of dressing and, when a few days later they reached the Gen- 
eral Hospital at Siboney, they had to undergo the same ordeal 
and often not only once, but as often as they came into the 
hands of another surgeon. Patients not thus treated were dis- 
satisfied, as the laymen are still laboring under the erroneous 
impression that the oftener a wound is dressed the quicker it 
will heal. It is difficult to eradicate such a deep rooted and 
time-honored belief, and patients will continue to clamor for 
a change of dressing, and the good-natured, hard-working sur- 
geons only too often yield to such unreasonable requests. The 
evil of meddlesome surgery has become very apparent during 
our brief Cuban campaign and has taught us an important 
lesson that must be heeded in the future. Our military sur- 
geons must learn to realize the value and importance of the first 
aid dressing. In all cases in which the first examination does 
not reveal the existence of complications which require subse- 
quent operative treatment the diagnosis tag should convey this 
important instruction: ^'Dressing not to he touched unless 
symptoms demand it. Such instruction is significant and must 



148 

be followed to the letter by all surgeons in subsequent charge 
of the patient. 

I am satisfied more than ever of the necessity of including 
in the first aid dressing package an antiseptic powder. For 
years I have used for this purpose a combination of boracic 
acid and salicylic acid, 4 : 1, with the most satisfactory results. 
I am also partial to absorbent sterile cotton for this particular 
purpose, as it constitutes a more perfect filter than loose gauze. 
A teaspoonful of this powder dusted on the wound forms with 
the blood that escapes and the overlying cotton a firm crust, 
which seals the wound hermetically. Should the primary 
dressing become saturated with blood, the same powder should 
be dusted over the wet dressing, and an additional compress 
of cotton is added to the dressing. After the first dressing has 
been applied it should not be removed except for good and sub- 
stantial reasons. Much can be done in the after-treatment in 
the way of readjusting the bandage and in immobilizing the 
injured part, but the first dressing must remain unless local or 
general symptoms set in which would warrant its removal. 
Malaria and yellow fever, that crept in upon us so insidiously, 
are responsible for many unnecessary changes of dressing. The 
appearance of fever in a wounded man naturally leads to the 
suspicion that there is something wrong in the wound. Many 
dressings were changed on this ground, nothing abnormal was 
found in the wounds, and a day or two later the nature of the 
fever was recognized and the patients were either given quinine 
or were sent to the yellow fever hospital, in accordance with 
the diagnosis made. Every change of dressing, more espe- 
cially in military practice, is attended by risk of infection 
and must be scrupulously avoided, unless local or general 
symptoms indicate the existence of complications ivhich de- 
mand surgical intervention. In writing the above it is not 
my intention to cast any reflection on the work of our surgeons ; 
on the contrary, I willingly bear witness to the ability, faith- 
fulness and unselfishness with which they have done their 
duty. A better and more conscientious group of medical offi- 
cers it would be difficult to select anywhere. The results on 
the whole are excellent, but I am hopeful that they can be 
improved in the future by placing more stress and attention to 
the value and importance of the first dressing, and wish to 



149 

repeat again and in a most forcible way the language of the 
late Professor von Nussbaum : ''The fate of the wounded 
rests in the hands of the one who applies the first dressing.'' 
If this is true in civil practice, its meaning can not be misin- 
terpreted in military surgery. 

EFFECTS OF BULLETS ON THE SOFT. TISSUES. 

In recent cases the small tubular wound made by the Mauser 
bullet was surrounded by a narrow zone of contused tissue, and 
the wound space itself filled either with liquid or coagulated 
blood. A few days later the wound itself was found surrounded 
with an area of suggillation, which varied in extent according 
to the nature of the tissues and the amount of extravasation. 
In cases in which the bullet passed through the tissues some 
distance, and not far from the surface of the skin the location 
and direction of the wound canal was indicated by discolora- 
tion of the skin a few days after the injury occurred. In a 
number of cases of aseptic wounds in which the bullet had 
lodged in the tissues and was removed a week or ten days later, 
I had an opportunity to study the remote effects of the injury 
on the tissues. In all cases the swelling of the tissues at this 
time had nearly or entirely obliterated the tubular wound, the 
location of which was indicated by a dark discoloration, paren- 
chymatous extravasation, remains of fluid or coagulated blood, 
and a limited area of edema and infiltration. These conditions 
served as a useful guide in following the course of the bullet. 
The bullet itself was usually found loose in a small cavity filled 
with liquid blood or bloody serum, while a more extensive zone 
of infiltration indicated the early stage of encapsulation. I 
have no further doubt but what the new bullet will become 
encapsulated and remain harmless in the tissues, as readily or 
more so than the old-fashioned leaden bullet. In isolated cases 
late suppuration at the seat of the bullet resulted in the form- 
ation of a circumscribed abscess, a complication which aided 
the surgeons in locating, finding and removing the missile. It 
was a surprise to us all to find that in more than 10 per cent. 
of all the wounded, the bullet was found lodged in the tissues, 
a vastly greater number than we had any reason to expect. 
The reason for this became apparent when we began to study 
the condition of the bullets removed. A large proportion of 
the bullets removed were found deformed, showing that they 



150 



were deflected bullets, which had struck a hard object or passed 
through a resisting medium before they reached the final ob- 
ject for which they were intended. The ground upon which 
the battle was fought is stony and covered with trees and thick 
underbrush, furnishing the most favorable conditions for de- 
flection of the missiles. Some of the firing was done at a great 



n 



u 





Fig. 1. Fig. 2. Fig.- 3. 

distance, so that occasionally a spent ball was found in the 
soft tissues without injury of the bones. Such a bullet is shown 
in Pig. 1. The bullet is a nickel encased Mauser projectile, 
natural size, the jacket perfect, and was removed from behind 
the tibia about four inches above the ankle joint. It entered 
the calf of the leg below the popliteal space and never touched 





Fig. Jt. Fig. 5. 

the bone. Fig. 2 represents the same kind of a bullet, the 
point flattened and mushroomed, removed from the head of 
the tibia. This bullet was probably fired from a great distance, 
and the deformity was produced by the bone. Figs. 3, 4, 5, 
represent a nickel clad bullet very much deformed. It was 
found lodged in the deep tissues of the thigh about two inches 



151 



from the wound of entrance, slightly overlapping the femur 
near the middle of the shaft. The bullet evidently struck a 
stone behind its point, and was deflected before it entered the 
tissues. It was much flattened and curved. Fig. 3 shows the 
convex side point of bullet and jacket perfect. Fig. i shows 
the edge and curve of the bullet. Fig. 5 represents the convex 
side, showing a wide rent in the jacket indicated by the dotted 
lines, the lead exposed between them. Figs. 6, 7, 8, illustrate 
the deformity of a large caliber brass-clad bullet. As the bul- 
let was removed from the soft tissues from a wound without 
bone injury, the deformity must have been caused outside of 
the body. The bullet is flattened on one side from a point near 
the tip to near the base of the lead core. Fig. 6 shows the 
convex side ; behind the last transverse groove the lead is ex- 





Fig. 6. 



Fig. 7. 




posed. Fig. 7 illustrates the flattened side of the dotted line, 
indicating a defect in the brass jacket. Fig. 8 shows the 
margin of the bullet, and the location and extent of flattening. 
As the Spanish army is armed exclusively with the Mauser 
rifle, the weapon from which this bullet was fired must have 
been in the hands of a volunteer, or possibly a Cuban. 

THE VALUE 0¥ THE X-RAY IN MILITARY PRACTICE. 

The use of the probe as a diagnostic instrument in locating 
bullets in modern military service has been almost entirely 
superseded by dissection and the employment of the X-ray. If 
from the nature of the injury and the symptoms presented the 
bullet is located in a part of the body readily and safely acces- 
sible to the knife and it is deemed advisable and expedient to 
remove it, this can often be done more expeditiously and with 



152 



a greater degree of certainty by enlarging the track made by 
the bullet than by relying on the probe in finding and on the 
forceps in extracting the bullet. If, as is often the case, the 
whereabouts of the bullet is not known, its presence and exact 
location can be determined without any pain or any additional 
risks to the patient by the use of the X-ray. All of the bullets 
removed on board the hospital ship Relief were located in this 
manner. Dr. Gray, an expert in skiagraphy, who has charge 
of the scientific work of the floating hospital, has been of the 
greatest service to the surgeons in enabling them to locate bul- 
lets and in guiding them as to the advisability of undertaking 
an operation for their removal. His large collection of skia- 
graph pictures will also furnish a flood of new light on the 
effects of the small caliber bullet on the different bones of the 
body. Dr. Gray's work will constitute an essential and endur- 
ing corner-stone of a much- needed modern w^ork on military 
surgery. The skiagraph has enabled us to diagnosticate the 
existence or absence of fracture in a number of doubtful cases 
in which we had to depend exclusively on this diagnostic re- 
source. In fractures in close proximity to large joints the 
X-ray has been of the greatest value in ascertaining whether 
or not the fracture extended into the joint. In one case of 
gunshot wound at the base of the thigh in which the bullet 
passed in the direction of the trochanteric portion of the femur, 
opinions were at variance concerning the extent of injury to 
the bone. Some of the surgeons made a diagnosis of fracture 
while others contended that there was no fracture but believed 
that the bullet had made a deep groove in the anterior portion 
of the bone and had possibly opened the capsule of the joint at 
the same time. The X-ray picture clearly demonstrated the 
absence of fracture and the existence of a deep furrow with 
numerous fragments on each side. The X-ray apparatus also 
proved of the greatest practical utility in showing the displace- 
ment of fragments in gunshot fractures of the long bones, 
which enabled the surgeons to resort to timely measures to 
prevent vicious union. The fluoroscope has greatly added to 
the practical value of skiagraphy. In the light of our recent 
experience the X-ray has become an indispensable diagnostic 
resource to the military surgeon in active service, and the sug- 
gestion that every chief surgeon of every army corps should be 



153 



supplied with a portable apparatus and an expert to use it, 
must be considered a timely and urgent one. 

THE WOUNDED OF THE BATTLE OE S-\>-TlAGO. 

It will be of interest to the profession to learn something defi- 




Fig. 9. 
nite of the nature of the wounds and their more remote results 
on the victims of Spanish bullets in the battle of Santiago. 
Two weeks have passed away since the battle. A considerable 
number of the wounded have died since, and many have left 
for the United States on the Olivette, Solace and transport 



154 



ships. x\moDg the 130 wounded now on the way to their homsB 
on the hospital ship, Relief, I have selected a number of cases 
of more than usual interest, for the purpose of studying the 
effects of the small caliber bullet, immediate and remote, on 
the different organs and regions of the body. It is my inten- 
tion to give the course of the bullets by marking on the dia- 
grams accompanying the report of each case, the wound of 
entrance and exit. A study of the diagrams will show that 
deflection of the bullet in the body is exceptional. Asa rule, 
the wound canal was in a perfectly straight line from one 
wound to the other. By following the track of the bullet it i& 
not difficult to determine the organ or organs implicated in the 
injury. I shall classify the cases so as to embrace gunshot 
wounds of 1, the head ; 2, the neck ; 3, the spine ; 4, the chest ;. 
5, the abdomen ; 6, the extremities. 

GUNSHOT WOUNDS OP THE HEAD. 

To my own knowledge, a number of gunshot wounds of the 
head that survived long enough to be transported to the gen- 
eral hospital at Siboney, died within twelve days after the 
receipt of the injury. In all of the cases intracranial infec- 
tion was the immediate cause of death. Encephalitis and 
leptomeningitis constituted the fatal complications. The be 
ginning of the intracranial inflammation was always announced 
by cerebral hernia, which in size was proportionate to the 
extent and intensity of the inflammatory process. The surgi- 
cal treatment resorted to in most instances proved powerless 
in limiting the infection. If these cases had been studied with 
a little more care during life, and if postmortem examinations 
had been made more frequently, valuable material could have 
been obtained for the advancement of the as yet imperfectly 
developed science of cerebral localization. 

Case 1. — Fred Shockley, Company D, Tenth Cavalry, 
wounded July 2. When injury was received the patient was 
lying on his abdomen with chest and head extended at the 
base of the ridge occupied by the enemy, which position readily 
explains the unusual course of the bullet. The bullet struck 
the occipital base at a tangent, producing a comminuted frac- 
ture with depression ; it then made a deep groove in the back 
of the neck and then re-entered the body on a level with the 
first rib to the left of the seventh cervical vertebra, passed 



155 



through the chest and escaped in front through the second 
intercostal space, a little to the left of the mammary line 
(Fig. 9). Soon after the injury was received he coughed up a 
small quantity of blood ; no hemorrhage since or any indica- 
tions of pneumothorax, pneumonia or pleuritis. The chest 
wounds healed by primary intention. At first had convulsions 
for a few moments ; no loss of consciousness, but clonic spasms 
of both arms. At present intellect is unimpaired ; has some 
headache and a sensation of throbbing in the head ; some im- 
pairment of motion and sensation of right leg and complete 
loss of motion of toes of right foot ; has some pain in eyes and 
slight dimness of vision. 

Case 2. — Patrick Ward, Company I, Third Cavalry, admit- 




Fig. 10. 



ted from hospital at Siboney to hospital ship, Relief, July 11. 
Injury probably received in the same manner as in Case 1. A 
large defect in the occipital bone marked the wound of entrance 
and exit in the skull, the opening enlarged by operation. The 
linear wound below, and extending as far as the last cervical 
vertebra, was undoubtedly made in following and removing 
the bullet. The cranial defect and course of bullet are out- 
lined in Figure 10. 

A cerebral hernia projects from the opening, and a deep- 
seated cerebral abscess was recently discovered, opened and 
drained. In part the hernia is covered by skin. Both parietal 
bones are the seat of a comminuted fracture. Mental facul- 



156 



ties not impaired ; no focal symptoms. The patient is losing 
strength rapidly and will soon succumb to the intra-cranial 
lesion. 

Case 5.— Jerome Russel, Company A, Thirteenth Infantry* 
was wounded July 1. When brought on board the Relief a 
cerebral hernia about the size of a hen's egg was found over 
the sagittal suture, an inch in front of the occipital protuber- 
ance. The wound was suppurating, and digital exploration 
revealed a small circular opening directly in front of the occip- 
ital protuberance. This opening was evidently the wound of 
entrance, and by operation, had been connected with the wound 
of exit by a channel an inch in length and half as wide. The 




Fig. 11. 

hernia occcupied the wound of exit. A number of loose frag- 
ments of bone have been removed at different times. There is 
marked hemiplegia on the left side, the forearm is strongly 
flexed and in close contact with the chest. Sensation is not 
diminished ; speech clear, but ideas confused ; pupils react to 
light ; incontinence of urine ; extensive decubitus over sacrum ; 
temperature 100.5 degrees F. ; pulse and respiration normal. 

Case 4. — B. C. Parker, Company C, Fourth Infantry, was 
wounded July 1. The bullet entered the left temporal region, 
comminuting the bone in that region extensively, and escaped 
over the left frontal eminence (Fig, 11). The cranial deifect 
was increased by the removal of a number of loose fragments. 
There had been quite a profuse sero-purulent discharge from 
the wound. The only focal symptom consists in a pricking 



157 



sensation in the right foot or chest when the wound is being 
dressed. His mind is clear most of the time, occasionally 
slight confusion and wandering. The absence of cerebral her- 
nia in this case is the surest indication that the infection is local. 

GUNSHOT WOUNDS OF THE NECK. 

Case 5. — Lieut. Albert Scott, Company C, Thirteenth 
Infantry, on July 1, while standing with his company at the 
foot of a hill, during the advance on Santiago, received a 
wound in the neck. The bullet entered the neck on the right 
side just below the inferior maxillary bone, one inch in front 
of the angle of the jaw. The wound of entrance is a clean cut 
hole about the size of a lead pencil. The course of the bullet 




Fig. 12. 
was backward and slightly downward, emerging at the back of 
the neck on a level with and to the left of the fifth cervical 
vertebra (Fig. 12). 

At the moment the injury was inflicted he felt no pain in the 
wound, but he experienced a sensation as if he had been 
grasped by the wrists and thrown violently to the ground. 
The wound of exit is of the same size and appearance as the 
wound of entrance. Very slight hemorrhage. A few minutes 
after receiving the injury he was carried from the firing line by 
members of his company, and was soon transported to the 
First Division Hospital, where he remained for ten days, after 
which he was removed in an ambulance to the hospital at 
Siboney, a distance of seven miles over a very rough road, and 
a day later was transferred to the Relief. 



158 



He first became aware of the existence of the wound on the 
way from the field to the hospital. At the time he came on 
board the hospital ship he was voiceless, and made constant 
efforts to clear his bronchial tubes of mucus. Complete par- 
alysis of right arm and leg, and partial loss of power in left 
arm and leg. Respiration normal, but an almost constant 
spasmodic cough, no control over sphincters, involuntary pas- 
sages from both bladder and bowels, great debility and profuse 
sweating ; complains of pain all over the body. Morphia and 
atropin given to subdue pain. A radiograph taken by Dr. 
Gray shows an injury of one of the cervical vertebrae, probably 
the fifth. Injury seems to be to the left of the body of the 
bone. Has received no treatment other than complete rest 




^Wa>i*<-^^ 



Fig. 13. 

and a nightly anodyne as noted above, which secures a good 
night's sleep, and markedly diminishes the sweating. Has 
regained control of the sphincters, and is able to use bed pan 
and urinal. 

July 19, — During the past six days there has been a decided 
improvement in the general condition of the patient. He is 
brighter in appearance, he can articulate more distinctly, and 
there is a decided return of power in the right leg. The right 
hand is still absolutely powerless, but the grip of the left hand 
is decidedly stronger. Appetite and circulation good. 

July 21. — Improvement in general condition still continues. 
The external wounds healed by primary intention, and the 
scars can only be seen on making a very careful inspection. 



169 



Trional and sulphonal have been substituted for the morphia. 

Case ^.— Oscar C. Buck, Company F, Second Infantry, was 
shot by a sharpshooter hiding in a tree, July 11. The bullet 
passed through the neck from side to side. The first and only 
evidence the patient had that he was injured was bleeding from 
the throat, the hemorrhage at first being quite profuse. Stiff- 
ness of the neck and pain on movement have been the only 
symptoms complained of since. The bullet entered over the 
sterno-cleido-mastoid muscle on the left side, about two and 
one-half inches from the mastoid process. The wound of 
entrance was circular and very small ; the wound of exit on 
the same level but about half an inch nearer the spine (Fig. 13). 
Three days later a small superficial abscess formed in the 
wound of exit, which was evacuated by dilating the wound. 
Both wounds were perfectly healed July 20. Judging from the 
course of the bullet it is difficult to understand how the princi- 
pal nerves and large vessels of the neck escaped injury. This 
is one of those cases that require careful watching, as a trau- 
matic aneurysm may develop later in the throat if the bullet 
injured the external tunics of either of the carotid arteries. 

Case 7. — Charles F. Flickinger-^ Company C, Fourth Infan- 
try, was wounded July 1, while lying down. The bullet 
entered the left posterior cervical triangle on a level with the 
spinous process of the fifth cervical vertebra, midway between 
the spine and the posterior border of the sterno-cleido-mastoid 
muscle, and emerged opposite the spinous process of the 
seventh dorsal vertebra, and equidistant from that point and 
the posterior border of the scapula (Fig. lla). The patient 
complains of severe pain in shoulders on attempting to move, 
but is free from any symptoms that would indicate any injury 
to the spinal cord. He was within 100 yards of the enemy 
when he was wounded. 

GUNSHOT WOUN'DS OF THE SPINE. 

All cases of gunshot wounds of the spine in which the cord 
was seriously damaged have died, or will die in the near future. 
The immediate cause of death in such cases is either a septic 
leptomeningitis or sepsis and exhaustion from decubitus. 
Death from the first named cause takes place early as the 
result of infection of the wound and extension of the inflamma- 
tion at the seat of the visceral injury along the meninges and 



160 



surface of the spinal cord. The first case of this kind I saw 
was at El Caney a few days after the battle of Santiago. The 
patient was a Spanish prisoner. I found him lying on the bare 
stone floor of the village church. The bullet had entered over 
the center of the spine at the junction of the dorsal with the 
lumbar vertebrae, its course apparently being directly forward. 
Complete paraplegia below the seat of injury. The bladder 
was distended, nearly reaching the level of the umbilicus ; 
incontinence of urine. The neck, trunk above the wound, and 
upper extremities rigid ; fever ; pulse rapid and small, counten- 
ance extremely pale. The wound was protected by a small 




Fig. 14a. 

dirty dressing, and was suppurating. I doubt not that 
the patient died in less than twenty-four hours after I saw him. 
Wounds of the spine without injury to cord were frequently 
attended by temporary paralysis varying greatly in degree and 
duration. 

Case 8.— George Kelly, Company C, Seventeenth Infantry, 
was shot July 1, while lying in a prone position. The bullet, 
which was fired from a blockhouse on the summit of a hill, at 
a distance of about 600 yards, entered the body at a point a 
little below and at the middle of the right ilium, and emerged 
from the opposite side about three inches below the crest of 
the left ilium (Fig. 14b). The patient asserts that he suffered 
intense pain immediately after he was shot, and that he is now 



161 



free from pain except when he attempts to walk. The pain 
thus caused he refers to the sacro- coccygeal articulation. The 
wounds are healed, and the absence of paralysis is the best 
evidence that the contents of the spinal canal escaped injury, 




Fig. 14b. 

although the bullet must have passed transversely through the 
first sacral vertebra. 

Case 9. — John Robinson, Company C, Twenty-fourth Infan- 
try. The bullet entered the supraspinous fossa of left scapual 
and escaped from the right lumbar region, having perforated 
in its long course the lung, spinal cord, diaphragm and liver 



162 



(Fig. 15). Wounds healed in ten days. Expectoration bloody, 
complete paraplegia. Beginning extensive decubitus over 
sacrum and spinous processes. 

Case 10.— Otto Derr, Company A, Twenty-first Infantry, was 




Fig. 15. 
wounded July 2. Bullet passed through the chest from side 
to side from the post-axillary line on the right side to a corres- 
ponding point on the opposite side, on a level with the seventh 
intercostal space. Complete paralysis of motion and sensation 
below the seat of spinal injury. The wounds healed, but life 
was|threatened at the time from a commencing septic decubitus. 



163 



Case 11.— Lewis W. Carlisle, Company K, Seventy-first New 
York Volunteers, was hit by a shrapnel in the back, on a level 
with the third lumbar vertebra, shattering the spinous and 
left lateral processes of the same. The missile was removed as 
soon as the patient reached the Division Hospital. As profuse 
suppuration set in and continued, the patient was anesthetized 
July 18, and a number of fragments of bone removed. A large 
abscess cavity in the right lumbar region communicated with 
the wound. The cavity was drained by making a counter- 
opening in line with Simon's incision. Impaired sensation in 
the right leg was the most important local symptom in this 
case. 

Case 12. — Charles J. Reardon, Company C, Sixteenth 
Infantry, was wounded by a fragment of shrapnel which struck 
him as he lay on his back with his shoulders raised ready to 
fire. The wound was directly over the spine, on a level with 
the fourth dorsal vertebra, the missile evidently opening the 
spinal canal and injuring its contents. The foreign body 
remains imbedded in the tissues ; its location so far has not 
been determined. Paraplegia is complete below the level of 
the umbilicus. On July 18 the patient was still alive, but an 
extensive moist decubitus became the direct cause of death in 
the course of a few days. 

GUNSHOT WOUNDS OF THE CHEST. 

It is well known that during the Civil War men 
had a better chance for life when the bullet passed through 
the chest than when the chest was opened and the ball remov- 
ed. The same remains true now, although not to the same 
extent, as the small caliber bullet is less likely to carry with 
it into the chest clothing or other infective material. The 
number of cases of chest wounds that lived long enough to 
reach the hospital on the coast is still more astonishing, and 
what is surprising is the fact that unless the hemorrhage was 
severe the symptoms were mild, some of the patients being 
confined to bed only for a few days. All of these cases were 
treated on the expectant plan, i.e., by dressing the external 
wound or wounds in the usual manner. In no instance was 
the pleural cavity opened for the purpose of arresting the 
hemorrhage. 



164 



Case 13. — Wm. A. Cooper, Company A, Tenth Cavalry, was 
wounded July 1. The bullet entered an inch below the left 
nipple, and escaped from the body an inch below the costal 
arch in the mammary line (Pig. 16). It is questionable whether 
the bullet opened either the pleural or peritoneal cavity, as the 




Fig. 16. 

injury was not followed by any symptoms referable to visceral 
wounds of the chest or abdomen, although the course of the 
bullet was such as to give rise to the suspicion that either or 
both of these cavities might have been invaded. 
Case 14. — Edward O' Flaherty, Company C, Sixteenth In- 



165 



fantry, was wounded July 2 by a 45-caliber ball from a bursting 
shrapneL The projectile entered below the angle of the right 
scapula, passed through the lung, diaphragm and liver, lodg- 
ing beneath the skin in front, between the seventh and eighth 
ribs (Fig. 17). Bloody expectoration for some time and slight 
rise in temperature. 




Fig. 17. 

July 12. — Temperature normal. 

July 21. — Patient suffers but little inconvenience from his 
wound. No peritoneal or pleural effusion. General condition 
promises an early and complete recovery. 



166 



Case 15. — John B. Semca, Company G, Twenty-second In- 
fantry, was wounded July 1, by a bullet which entered hi& 
back just below the angle of the left scapula, passed upward 
through the lung, neck and jaw and emerged through the 




Fig. 17. 
alveolar process of the right bicuspid tooth, cutting the tongue 
slightly (Fig. 18). All wounds healed in a short time by pri- 
mary intention. Hemoptysis profuse immediately after he was 
shot, and slight for the following few days. Left arm at first 
nearly powerless, with desquamation of skin of the hand. 
Function of the arm is returning gradually. In three weeks 



167 



the patient was able to sit up for a short time each day. Phy- 
sical examination of the chest at this time revealed nothing 
abnormal. 

Case 16. — Winslow Clark, Company G, First Volunteer Cav- 
alry, was wounded July 1, by a bullet which entered the chest 




Fig. 18. 

by first perforating the left scapula through the infraspinous 
fossa, three inches above the angle and a inch from the spinal 
border (Fig. 19). No wound of exit. The probable course of 
the bullet was downward and forward. Some hemoptysis and 
fever. No vomiting of blood. The hemothorax was quite 



168 



extensive and was relieved by tapping, a week after the injury. 
He is now (July 22) convalescing rapidly. 

Case 17. — Arthur Fairbrother, Company C, Third Cavalry, 
sustained a perforating gunshot wound of the chest July 1. 




Fig. 18. 

The bullet entered the chest just below the middle of the right 
clavicle (Fig, 20). No wound of exit. Hemoptysis rather pro- 
fuse, followed by hemothorax. Has had fever, off and on, 
probably malarial. Patient was admitted to the Relief July 15. 
Wound not completely closed. On coughing, dark fluid 



169 



blood escapes. Nearly the entire pleural cavity filled with 
blood. Two days later three pints of dark fluid blood were 
removed by tapping and siphonage. Sputum at this time still 
bloody. 




Fig. 19. 

July 22. — Patient much improved. No signs of empyema. 
Hemothorax diminished, but may require a second tapping. 

Cci^ 18. — Scanlon, Company K, Third Cavalry, was wounded 
on the second day of the battle of Santiago. The ball entered 
thejchest through the third rib midclavicular line on the right 



170 



side, passed downward and backward and escaped in the gluteal 
region on the same side, after perforating the ilium (Fig. 21). 
The ball must have passed through the lung, diaphragm and 
liver. Hemoptysis slight, but distressing nausea, vomiting and 
pain. Admitted to the hospital ship Relief July 15. At that 
time he had a constant temperature ranging between 100 and 
102 degrees F., vomiting, diarrhea and rapid emaciation. Great 
pain over the liver and ascending colon. Hemothorax and 
marked swelling in the region of the liver and abdominal cavity 




Fig. 20. 

on the right side. Examination of urine negative. Owing to 
the great debility and pronounced anemia it was not deemed 
advisable to resort to laparotomy. 

Case 19. — Harry Mitchell, Company C, Seventh Infantry, 
was wounded July 1. The bullet entered over the right acro- 
mion process, passed through the apices of both lungs and, 
escaped through the second intercostal space above the right 
nipple (Fig. 22). No hemoptysis at any time, dry cough and a 
moderate hemothorax on the right side. Has suffered from 
quotidian form of malarial fever, which is yielding to quinin. 
A speedy and complete recovery is expected. 



171 



Case 20.— Jjieut John Robertson, Company G, Sixth Infantry, 
received a gunshot wound of the upper third of right thigh 
about 10 o'clock July 1. The profuse hemorrhage was partly 
controlled by an improvised tourniquet applied by an officer of 
the line. He was carried to the rear by the men of his com- 




Fig, 21a. 

pany, and while thus conveyed he was shot in the left breast, 
the bullet entering just below the left nipple and passing 
through the chest in an antero-posterior direction (Fig. 23). 
He was wounded a third time, the bullet grazing the inner side 
of the left knee. The first dressing was applied in the First 



172 



Division Hospital. The fracture of the thigh was dressed by 
the use of a long splint. From here he was sent, on July 9, to 
the Third Division Hospital, and two days later was brought 
on board the Relief. At this time both chest wounds were 
healed. The thigh wounds remained aseptic. A radiograph 




Fig. 21b. 

showed great displacement of the fragments by overlapping. 
The fracture was then treated by confining the limb upon a 
double-inclined plane, consisting of a hollow posterior splint 
made of the sheath of the leaf of the cocoa palm, to which 
was added an anterior thigh splint of wire gauze. After dress- 



173 



ing, the limb was placed in a sling. No pulmonary or pleuritic 
complications. 

Case 21.— Henry T. Darby, Company D, Thirteenth Infantry, 
received a perforating gunshot wound of the chest July 1. The 
ball entered on the right side, above the angle and at the outer 




Fig. 22. 



border of the right scapula, passed through the chest and 
escaped through the fourth intercostal space in front, on the 
opposite side, two inches outside of the mammary line (Fig, 24.) 
When the patient came on board the Relief, July 9, he com- 
plained of great difficulty in breathing ; he was pale and greatly 



174 



prostrated; temperature 102 degrees F. The physical signs 
indicated the presence of a copious pleuritic effusion on the left 
side. The chest was opened by an incision through the sixth 
intercostal space, in the axillary line, July 11. About three 




Fig. 23. 

pints of fluid blood escaped. Gauze drainage. The lung ex- 
panded rapidly and the patient commenced to improve. 

No further doubt can remain in regard to the difference in 
the mortality of gunshot wounds inflicted with the large and 
small caliber bullets. The cases related above appear to prove 
that the danger incident to gunshot wounds of the chest made 



175 



by the small projectile, consists in complicating injuries involv- 
ing the heart and large blood-vessels, and that in the absence 
of such injuries the prognosis is favorable. It seems that em- 
pyema is a rare remote result of such injuries. Rib resection and 
free incision and drainage of the chest in such instances must 
be reserved for cases in which a positive diagnosis, of empyema 
can be made. The safest and best treatment for hemothorax 
requiring operative interference is tapping and evacuation by 
siphonage. 




Fig. 24a. 



GUNSHOT WOUNDS OF THE ABDOMEN. 

Our recent experience in Cuba has more than ever confirmed 
my conviction that not infrequently cases of penetrating gun- 
shot wounds of the abdomen will recover without active 
surgical interference. For years I have maintained, as the 
result of clinical experience and experiments on the cadaver, 
that a bullet may pass through the abdomen on a level and 
above the umbilicus in an antero -posterior direction without 
producing visceral injuries demanding operative intervention. 
Elsewhere the results of my experience and experimentation 
concerning such injuries have been published. If the bullet 



176 



traverses the small intestine area it is more than probable that 
from one to fourteen perforations will be found. 

Four laparotomies for perforating gunshot wounds of the 
abdomen were performed in the First Division Hospital, the 
only ones, to my knowledge, during the Cuban Campaign. 
All of the patients died. This unfavorable experience should 
not deter surgeons from performing the operation in the future 
in cases in which from the course of the bullet it is reasonable 
to assume that the bullet has made visceral injuries which 
would be sure to destroy life without surgical interference. 




Fig. 24b. 



In other cases the employment of diagnostic tests for the pur- 
pose of demonstrating the existence or absence of intestinal 
perforations will enable the surgeon to decide what course to 
pursue. Abdominal section is always justifiable in cases of 
internal hemorrhage sufficient in amount to threaten life. 

A number of cases of gunshot wounds of the abdomen have 
been related in connection with gunshot injuries of the neck 
and chest, in which the cavity of the chest and abdomen and 
their contents were implicated at the same time, and which 
are on the way to recovery without laparotomy having been 



177 



performed. I have seen a number of cases of perforating^ 
wounds of the abdomen in the First and Third Division Hos- 




Fig. 25a. 
pitals that were on a fair way to recovery without operation 
before they were sent home on transport ships. In most of 
these instances the bullet wounds were either in the umbilical 



178 



region or one of the iliac fossae. The following case presents 
features of more than usual clinical and surgical interest : 

Case 22, — J. F. Taylor, Company D, Tenth Cavalry, was 
wounded July 2. At the time the injury was received he was 



\i 



Fig. 25b. 
in the ventral prone position. The bullet entered the left 
shoulder in the infraspinatus fossa one inch below the spinous 
process of the scapula, and passed downward and inward and 
lodged under the skin in the median line, two inches above the 
umbilicus (Fig. 25). Hemoptysis considerable during the first 
day, when it gradually subsided. He complained of great pain 



179 



and tenderness in the right side of the abdomen. No vomiting 
or symptoms of more than a circumscribed peritonitis. An 
abscess formed in the abdominal wall, which was opened July 
20, and the bullet was removed. From this time on the pati- 
ent improved rapidly. 



W 



Fig. 26a. 
GUNSHOT WOUNDS OF THE EXTREMITIES. 

It is a source of gratification to know that very few primary 
amputations were made for gunshot injury of the extremities. 
All of the surgeons realized the importance of conservative 
measures in the treatment of such injuries, and limited ampu- 



180 



tation to cases in which the condition of the soft tissues pre- 
cluded such a course. A number of secondary amputations 
became necessary to save life in cases of infected compound 
fractures, usually complicated with injury and infection of the 
adjacent joint. Two cases of traumatic aneurysm are now on 



I 



Fig. 26b. 
board the Relief, one an aneurysmal varix, the other an aneur- 
ysm of the femoral artery. 

Case 25. — Captain Mosher, Company G, Twenty-second 
Infantry, received a bullet wound July 1, during the advance 
on Santiago. Those who saw the patient first assert that the 
hemorrhage was severe, and that the patient lost conscious- 



181 



ness. He was removed to the First Division Hospital and 
transferred July 10 to the Third Division Hospital, and the 
following day he was brought on board the Relief. I exam- 
ined the patient at the front five days after the injury and con- 
firmed the diagnosis made by the attending surgeons, who had 
recognized the anatomic nature of the aneurysm. 

The wounds healed by primary intention in less than two 
weeks. One wound is in the middle of Scarpa's triangle and 
the other at the level of, and one inch posterior to the great 
trochanter on the same side. From the fact that there is, as 
shown by the radiograph, a piece of the jacket of a bullet in 
the right popliteal space, it is probable that he was wounded 
by a plunging fire and that the bullet inflicted the latter wound 
after emerging from the wound in Scarpa's triangle. The 
wound in the popliteal space is suppurating. Patient is very 
anemic and weak. In the triangle directly under the wound 
there is a pulsating swelling in the direction of the femoral 
vein, which extends to Poupart's ligament. Fremitus and the 
characteristic bruit extend a considerable distance above and 
below the communicating opening between the artery and vein. 
The treatment consists in rest and tonics. General health of 
the patient is improving, but there is no change in the local 
condition. The mental condition much impaired since the 
injury is gradually improving. 

Case 24. — John J. Welch, Company M, Second Massachu- 
setts Volunteers, was wounded July 1. The bullet entered 
the middle and back of Scarpa's triangle, three inches below 
Poupart's ligament, directly over the femoral artery, and 
escaped at a point corresponding with the gluteal crease and 
to the outside of the femur on the same side (Figure 26). 
Not much hemorrhage. A well-marked aneurysm developed, 
presenting all the physical signs characteristic of such a path- 
ologic condition. The swelling is somewhat elongated, a little 
larger than a hen's Qgg, and has not increased in size since the 
patient came on board the hospital ship. The leg is somewhat 
edematous and painful. A number of gunshot fractures of 
the thigh and leg have become infected and are now being 
treated by establishing free tubular drainage and resorting to 
frequent or continuous antiseptic irrigation. Owing to the 
want of reliable plaster of Paris, we had to resort to various 



182 



kinds of splints, single and double inclined plane, in effecting 
immobilization. The sheath of the leaf of the cocoa palm has 
served as an excellent material for this purpose. There is 
every prospect that most of these cases will utimately recover 
with useful limbs. 

In conclusion I desire to thank Acting Assistant-Surgeons 
Metcalfe, Torney, Greenleaf , Hartsock, Morrow and Schultze 
for valuable assistance in preparing this communication. 



THE SURGERY OF CAMP WIKOFF. 



The great national Camp Wikcff has been made the recip- 
ient of the returning army of Cuba. Three months ago the 
invasion of Cuba was ordered. Our troops left the different 
camps in excellent condition and good cheer to meet the Span- 
ish army in the neighboring island, fully informed and impressed 
with the events that awaited them. The army of invasion 
considered it a privilege to be called to the front to represent 
the military prowess and power of this country. The outside 
world had no conception of what our army could accomplish at 
such short notice in a distant tropical country. The authori- 
ties, and particularly the medical department, were fully 
aware of the fact that the invasion of Cuba meant more a 
battle with climate and disease than the weakened, sickly, 
half starved Spanish forces. The invasion was planned on the 
spur of the moment, and the corps were rushed to the front with 
a haste that appeared all out of proportion to the conditions of 
things as they presented themselves at the seat of war. It was 
decided that our flag should float over the city of Santiago on 
the Fourth of July regardless of consequences. The army of 
invasion was packed on transports days before the final order 
was given to sail. Here was one of the many causes that 
impaired the health of our troops. The lack of harbor facili- 
ties on the coast of Cuba, where our army landed, made dis- 
embarkment and the landing of supplies exceedingly difiicult. 
Most of the barges intended for this purpose were wrecked 
during the voyage, a serious loss which could not be remedied 
in time. Much suffering was caused by the lack of efficient 
landing and transportation facilities. Our troops were sup- 
plied with rations calculated for our climate, but not adapted 
for a tropical country. Our soldiers were exposed at once to 
malarial infection in all of the camps. Occupation of the 
buildings in which yellow fever had full sway for years, and 
the free intermingling of the filthy Cuban refugees and soldiers 
with our troops could not fail in starting and disseminating 



184 



this disease among our soldiers soon after landing on Cuban 
soil. Typhoid fever, which prevailed in all of our large camps 
before the army sailed for Cuba, soon gained a firm foothold 
at the seat of war and did its share in increasing the mortality 
and in shattering the efficiency of the service. Amebic 
dysentery and diarrhea, the two greatest enemies of the Span- 
ish army, thinned out our ranks and crowded our imperfectly 
equipped hospitals. It was fortunate that the enemy yielded 
to our arms so early, and made it possible for our troops to 
return so soon to the invigorating climate of the North for 
proper care and speedy recuperation. Those who saw the 
different regiments leave our State and national camps would 
find it difficult to recognize and identify the soldiers of the 
Cuban campaign. The men left in excellent spirits. Most of 
them return as mere shadows of their former selves. The pale 
faces, the sunken eyes, the staggering gait and the emaciated 
forms show only too plainly the effects of climate and disease. 
Many of them are wrecks for life, others are candidates for a 
premature grave, and hundreds will require the most careful 
attention and treatment before they regain the vigor they lost 
in Cuba. The surgery of Camp Wikoff represents cases and 
pathologic conditions which we would expect to occur in men 
suffering from the effects of disease, exposure and the debili- 
tating effects of a tropical climate. Our work has consisted 
largely in the treatment of abscesses and operations for fistula 
ani and hemorrhoids. I was ordered to Camp Wikoff on my 
return from Porto E-ico, and reported for duty August 22. The 
field operating tent and surgical wards, already in construc- 
tion, were completed in two days. I have been assisted in my 
surgical work by Major Charles Adams, U. S. V., and Acting 
Assistant-Surgeon Henry Greenleaf. The Sisters of Charity 
have charge of the surgical wards, and two of them make the 
necessary preparations for operation and assist in the operat- 
ing tent. 

SURGICAL HOSPITAL. 

The surgical hospital at Camp Wikoff is a part of the gen- 
eral hospital. It consists of nine wall tents, placed end-to-end 
and supported by a substantial wooden frame and floored 
throughout, constituting a pavilion of 126 x 14 feet in extent. 
The front tent. No. 1, facing southeast, boarded at the sides, 



185 



with a broad table shelf on either hand, Is used as an operat- 
ing tent. It is equipped with a regulation operating table, 
iron frame and top. Sterilized dressings, gauze sponges, liga- 
tures, etc., are kept in sterilized towels in readiness for use at 




Major Heitzmann, Surgeon U.S.A. 

any moment. The shelves and tables are covered with white 
rubber cloth, which is kept scrupulously clean. The instru- 
ments, after sterilization, are kept in trays containing a 2 per 



186 



cent, solution of carbolic acid. Saline and antiseptic solutions 
are kept ready for use in four-gallon bottles. All surgical 
paraphernalia not in use are covered by clean white sheets. 
The second tent, open at the sides for free ventilation and cool- 
ness, is used for the office of the surgeon in charge. It is sup- 
plied with a field desk, table and chairs. Section No. 3 is the 
preparation room. The instruments are kept here under lock 
and key. Two sterilizers, basins, buckets, pitchers and a table 
constitute the equipment of this room. A glass irrigator and a 
number of fountain syringes furnish the facilities for irrigation. 
A field operating case, a Paquelin cautery, a full set of dental 
forceps, a complete set of urethral instruments, a case of eye 
and ear instruments and aspirator have furnished all the instru- 
ments required. The instruments are sterilized by boiling, 
the dressings by dry heat. 

Hand disinfection consists in scrubbing for at least five min- 
utes in hot water and potash soap, washing in absolute alcohol 
followed by prolonged immersion in a 1-1000 solution of bichlo- 
rid. Just before the operation is commenced the hands are 
washed once more in alcohol. The field of operation is disin- 
fected in the same manner as the hands. Section 5 answers the 
purpose of a pantry and kitchen for special diet. From here 
the distribution of food takes place as it is received from the 
main kitchen of the hospital. Between the supply tent and 
the pantry is an open passage-way four feet wide, through 
which the patients and nurses enter and leave the hospital. 
The four tents remaining are used for wards, having a capacity 
of 32 beds. This hospital in the course of a few days was filled, 
when ward A, adjacent, occupied by medical cases, was evacu- 
ated to make room for surgical cases. The present arrange- 
ments affords room for seventy-five surgical patients. At the 
present time, September 10, every bed is occupied. The six 
Sisters of Charity in charge are assisted by three orderlies from 
the Hospital corps. Patients are prepared for operations with 
proper antiseptic precautions, and no pains are spared to give 
them the benefit of modern surgical methods in every detail, 
during their stay in the hospital. The nursing and care of the 
sick are faultless, and the diet is not only ample in quantity 
and quality, but often luxurious, far exceeding what is served 
on the table of the officers mess tent. The patients much re- 




Majok Browx, Surgeon U.S.V., in his Office, General 
Hospital, Camp Wikoff. 



188 



duced in flesh and strength by fever or suppurative affections, 
are furnished with a liberal supply of stimulants including 
champagne and port wine. With very few exceptions indeed, 
prompt improvement has followed the operative interventions, 
more especially in the cases of large phlegmonous and ischio- 
rectal abscesses. It is my intention in writing this paper to 
give the profession a general idea of the surgical work done in 
Camp Wikoff since I took charge of this branch of the hospi- 
tal work August 22. Nothing had been done up to that time 
in caring for the surgical cases. The hospital was over- 
crowded, and the available physicians were extremely busy in 
looking after the welfare and accommodation of the fever pa- 
tients. In two days I had the surgical ward in a condition to 
receive patients, and on the third day the first operations were 
performed. At first a pocket case did sole duty in the operat- 
ing room. The hospital outfit and supplies were picked up 
here and there, and in a few days we were ready to begin sys- 
tematic, efficient work. Many of the patients were so weak 
and anemic that the administration of an anesthetic was 
deemed dangerous. In such cases the patients were given 
strychnia subcutaneously and a liberal dose of whisky by the 
mouth. Patients considerably enfeebled by disease were given 
ether in preference to chloroform. Chloroform by the drop 
method was the anesthetic of choice in all cases where the gen- 
eral conditions of the patient did not contraindicate its use. 
Operations were performed during the forenoon, beginning at 
9 o'clock. 

TOOTHACHE. 

Of the organs frequently affected among the returning sold- 
iers were the teeth. Patients suffering from carious aching 
teeth were numerous. In most instances they presented evi- 
dences of serious malnutrition following disease and exposure ; 
suppurative alveolitis was less frequent. Infection of many 
oral cavities showed that teeth had been sadly neglected dur- 
ing the campaign. In Cuba and Porto Rico I saw occasionally 
a soldier with a tooth brush under the hat band, but I have 
reason to believe that most of the tooth brushes were either 
left at home or thrown away on the march, as unnecessary 
articles of the limited toilet outfit. I did all I could in the way 
of conservative dentistry by cleaning out cavities and packing 



189 



with cotton saturated with carbolic acid, but in the majority 
of cases the patients returned and insisted on having the pain- 
ful tooth extracted. Tooth extraction was a conspicuous and 
grateful part of the surgery of Camp Wikoff. Hardly a day 
passed without two or three such operations. A very complete 
set of tooth forceps furnished by the government did good ser- 
vice in relieving the victims of toothache of their agonizing suf- 
fering. Much has been said in favor of attaching a dentist to 
each regiment to look after the teeth of the men, and the ob- 
servations made in Camp Wykoff tend to support the propriety 
of such a much-needed addition to the medical service. It is 
interesting to know that among these patients there was not a 
single officer, undoubtedly because the officers were more par- 
ticular in the care of their teeth than the privates. 

HERNIA. 

The number of hernias that presented themselves in Camp 
Wikoff astonished us all. In every case the statements of the 
patients were to the effect that the hernia appeared since the 
enlistment. It might be surmised that at least in some of the 
cases this physical defect was overlooked during the examina- 
tion. This might have been so in isolated instances, in the 
case of volunteers, but such a view would not hold good in men 
belonging to the regular army. I saw more cases of hernia in 
men belonging to the latter, than the former branch of the 
military service. Our army in Cuba was not subjected for any 
length of time to hard marching or violent exertions of any 
kind, consequently the causes which led to hernia must be 
sought outside of such mechanical influences. Careful exam- 
ination appeared to prove that in most, if not in all cases, the 
hernia was of recent origin. I attribute the hernia-formation 
principally to the relaxation of tissue, caused by disease and 
its effects, aided undoubtedly by the prevalence of intestinal 
affections which must have often resulted in increased abnor- 
mal intra abdominal tension. The uncertainty of the duration 
of the encampment induced me to advise against operative in- 
terference, and in most cases the general condition of the pa- 
tients was such as to constitute in itself a strong contraindica- 
tion to the performance of a radical operation. The patients 
were fitted with a truss and advised to have a radical operation 



190 



performed after their general health was restored, after leav- 
ing the service or obtaining a furlough. 

VARICOCELE. 

The frequency with which varicocele is met with in men from 
18 to 45 years was shown in the examination of 9901 volunteers 
in Camp Tanner, Illinois. As a member of the board of exam- 
iners, I was very anxious to obtain accurate information regard- 
ing this subject, and accurate notes were kept at the time. 
We found varicocele, slight, 992 ; medium, 692 ; large, 295. Of 
the slight cases 10 were double, 7 of the right side only ; of the 
medium cases, 7 were double, and 4 of the right side only ; of 
the large cases 4 were of the right side only. The percentage 
of varicoceles to total number examined was 21.17. Only six 
were regarded as physical disabilities, and those on account of 
size and pain. At that time I wrote a paper calling attention 
to the great frequency of varicocele in men of the age for mili- 
tary service, and claimed that ordinary varicocele was no valid 
objection to the enlistment of men for military duty. Of the 
more than 15000 men who returned from Cuba and were 
landed at Montauk, only five cases of variococele applied for 
treatment at the surgical ward. In all of these cases the local 
symptoms were such as to warrant an operation. The opera- 
tion was performed by excising through a straight incision, 
directly over the cord, the enlarged veins between double liga- 
tures. The veins were carefully isolated by dissection from 
the spermatic cord and the accompanying artery. After excis- 
ion the two stumps were brought together by a single catgut 
suture, and by tying over this a thread of one of the ligatures 
left long from each side. The stumps were buried by several 
fine catgut sutures with which the deep layers of the tissues 
were united. The external wound was always closed with 
horsehair sutures. Elongation of the scrotum sufficient in de- 
gree to require attention was corrected by transverse suturing 
of the external wound. The wound was sealed with collodium, a 
few narrow strips of iodoform gauze, and a pledget of absorbent 
cotton over which the usual dressing and bandage were applied. 

Case 1. — John D. Deboer, aged 24, colored ; Troop B, First 
Cavalry ; has had varicocele for the last eighteen months. En- 
listed five weeks ago. Marked ectasia of the spermatic veins 
on the left side with corresponding elongation of scrotum oa 



191 

same side. He has had no pain, but much discomfort in hot 
weather from relaxation and dragging sensation. Operation 
under chloroform narcosis August 31. General health not 
much impaired. 

Case 2. — William Cantwell, age 31, Company B, Sixteenth 
Infantry ; has been in the service fourteen years. Varicocele 
appeared eighteen months ago. Since he entered the active 
service the swelling has often been painful, especially during 
forced marches and in hot weather. He is much concerned 
about his condition, and submitted willingly to the operation, 
which was performed under ether anesthesia September 3. 
On exposing the varicose veins it was found that the tunica 
vaginalis had remained patent from the external inguinal ring 
to the testicle, but contained no fluid. The veins were isolated 
with some difficulty from the cord and the spermatic artery. 
After disposing of the vein stumps in the usual way the tunica 
vaginalis was closed with fine catgut sutures over the cord. 
The scrotum was shortened by transverse suturing of the 
wound. 

Case 3. — Wm. Reed, age 23, colored ; Troop H, Ninth Cavalry. 
Made its appearance soon after his enlistment two months ago. 
The varicocele is of large size and gives rise to much pain on 
riding or walking any distance. Operation under chloroform 
narcosis September 3. 

Case 4. — Robert Duseman, age 21, Second Volunteer Engin- 
eers. Entered the service two months ago. Six weeks ago, 
during drill, he bruised the left side of the scrotum, and 
attributes the varicocele to this cause. He complains of a 
dragging sensation in the testicle on the left side, the seat of 
the varicocele of medium size. Usual operation under ether, 
September 11. 

In all of these cases the general health of the patients was 
not much impaired, and the wounds healed rapidly by primary 
intention. 

HYDROCELE. 

Hydrocele from puberty to the age of 45 occurs much less 
frequently than varicocele. Of the 9901 cases examined in 
Camp Tanner, we found only 49 cases of hydrocele of the 
tunica vaginalis and 18 of the cord. Only one case of hydrocele 
of the tunica vaginalis came for treatment to the surgical ward 
of Camp Wikoff. 

Case 5. — John Craigie, Company E, First Artillery, a young 
soldier whose health had become greatly undermined by malaria, 
was sent from the medical to the surgical ward, for a painful 
affection of the left testicle of a few days' duration. Patient 
Tery anemic and emaciated. A few days ago, on recovering 
from his illness for which he had been sent to the hospital, the 



192 

left testicle became painful and tender, accompanied by a 
gradually increasing swelling. He came under surgical treat- 
ment August 27. Careful examination revealed an acute hy- 
drocele of the tunica vaginalis on the left side, without any 
palpable visceral lesions of the testicle or epidydimis. The 
fluid, straw colored, was evacuated by tapping with a small 
trocar. One dram of equal parts of alcohol and carbolic acid 
was injected. The reaction was moderate and the patient left 
a few days later, the swelling gradually diminishing in size. 

BONES AND JOCNTS. 

Only a few cases of injury and disease of bones and joints 
came under observation in the surgical department of the 
general hospital, but these isolated cases present features of 
interest sufficient to justify mention in connection with the 
subject of this communication. 

Case 6,— Gunshot fracture of femur. S. M. Wetmore, 
age 25, trumpeter, Troop D, First Volunteer Cavalry, was 
shot through the right thigh at the junction of the lower with 
the middle third, the bullet passing in the antero posterior 
direction, the wound of exit being on a higher level than the 
wound of entrance. The wounds were dressed with idoform 
and healed by primary intention. Just before he was trans- 
ferred from the hospital at Siboney to the Relief he became 
very much debilitated and manifested other and more charac- 
teristic symptoms of iodoform intoxication. A plaster cast 
was applied, and he was sent to the fever camp as a case of 
yellow fever— a diagnosis which was never confirmed by the 
physicians in charge of the hospital. He suffered from mala- 
ria, and his present condition indicates to what extent the 
malarial intoxication has advanced. He is extremely anemic, 
and emaciated to a skeleton. The spleen is much enlarged^ 
The fractured limb is shortened two inches and a half ; marked 
overlapping of fragments ; union fibrous. Plaster of Paris 
bandage reapplied. Tonic and stimulating treatment. 

Ca^'e 7.— R. Whitington, aged 25, First Volunteer Cavalry, 
on August 14: was riding bareback, when his horse made a 
quick turn and in tumbling over an embankment the horse 
fell upon his left leg, producing an oblique fracture of the 
tibia about two inches above the base of the malleolus, and of 
the fibula about four inches higher. For some days the limb 
was placed in a fracture box, but it was found impossible to 
immobilize the fragments properly. During this time the 
patient suffered from pain and loss of sleep. August 27 he 
was placed under the influence of chloroform, the fragments 
were properly adjusted and the limb immobilized in a plaster 
of Paris splint extending from the base of the toes to the 
knee. Since that time he has been free from pain and has 
slept without the use of anodynes. 



193 

Case 8. — Maj.-Gen. S. B. M. YouDg injured his ankylosed 
elbow-joint, September 2, and received first aid at the surgi- 
cal ward the next morning. During the War of the Rebellion 
he received two gunshot wounds of the right arm. One shat- 
tered the lower third of the humerus, the other perforated the 
elbow joint. After a prolonged siege of suppuration he finally 
recovered with ankylosis of the elbow-joint, in flexion at an 
angle of about 110 degrees, and in a position of marked pro- 
nation. September 1 he stumbled and fell, striking upon the 
hand and elbow. He complains of severe pain in and about 
the joint. The elbow-joint is swollen and very painful on 
pressure and manipulation. Ecchymosis over both condyles. 
There is some motion but no crepitation, indicating the exist- 
ence of ruptured intra and periarticular adhesions. The patient 
states that this is the fourth time since the ankylosis occurred 
that it has been broken by injury of some sort. The limb was 
padded with a thick layer of cotton from the base of the 
fingers to the shoulder-joint, over which a light plaster of Paris 
bandage was applied. The patient was placed in charge of 
Major Nancrede, his attending physician, who a few days later 
substituted for the plaster dressing an angular wire splint. 
In less than a week he reported for duty at Camp Meade. 

Case 9. — Thomas A. McDonald, age 24, Second Infantry. 
While in action before Santiago the stock of his gun was 
struck by the fragment of a shell, the arm was violently 
twisted and the radius fractured. The forearm now presents 
the characteristic "silver fork" deformity of an imperfectly 
reduced Colles' fracture. There is swelling of the wrist, ina- 
ability to use fingers, and pain on attempted pronation and 
supination. Massage, manipulation and electricity advised. 

Case 10. — Preston Guthrie, aged 34, Company F, Twentieth 
Infantry, re-enlisted three and one-half months ago. States 
that he cut his left arm two years ago. The wound was slow in 
healing and left a scar adherent to the underlying ulna. 
Nothing in the clinical history would indicate that the bone 
was affected at that time. A contusion of same region occured 
while loading a transport in Cuba, which was followed by a 
complexus of symptoms pointing to the existence of a central 
osteomyelitis. An abscess which formed later ruptured 
through the old scar, an occurrence which was followed by 
prompt relief. A moderate discharge has continued since. 
Examination made August 26 disclosed two fistulous openings 
over the posterior surface and center of the ulna, leading into 
a central osteomyelitic cavity. Ulna at the seat of disease con- 
siderably enlarged. Through a straight incision the fistulous 
openings in the involucrum were exposed and the cavity freely 
laid open by chiselling. A sequestrum lying loosely in the 
bone cavity was removed and the granulations lining the 
cavity scraped out by a vigorous use of the sharp spoon. 
After thorough disinfection of the cavity the periosteum was 



194 

sutured carefully, over which the wound was closed in the 
usual manner, leaving only a small space for gauze drainage. 
The wound remained aseptic and healed rapidly by primary 
intention. 

Case 11. — George Oppel, aged 21, enlisted in the Second 
Infantry one month ago. He was admitted to the surgical 
ward with a fluctuating swelling over the inner aspect and a 
little above the left knee-joint. Ten years ago he was struck 
in this region with a brick and suffered from an acute bursitis. 
The bursa has been enlarged ever since, but has not been pain- 
ful until recently. There is no tubercular history in his 
family. The swelling is flat and in circumference is as large 
as a medium sized orange. On palpation no fluctuations can 
be felt, the sensation imparted being of a semi-elastic nature. 
The swelling is somewhat tender to touch and is painful when 
he attempts to walk. August 31, the patient being under the 
influence of a general anesthetic, the bursa was punctured 
with a small trocar in three different directions through the 
same opening in the skin and was thoroughly injected with a 5 
per cent, solution of carbolic acid. Pressure was applied over 
the bursa and the limb immobilized upon a posterior splint. 
In the course of a week the swelling had almost entirely disap- 
peared and the patient returned to his command for duty. 

REMOVAL OF FOREIGN BODIES. 

Two interesting cases of removal of a foreign body lodged in 
the tissues presented themselves for operative treatment. 

Case 1^.— Benjamin Nelson, age 23, Company F, Third 
Infantry. Came under observation and treatment September 
6. Three years ago he fell backward against a window and 
sustained several cuts of the scalp by fragments of broken 
glass. The wounds healed rapidly without suppuration. 
After his recovery he was aware of the presence of a piece of 
glass which had remained encysted in the pericranial tissues 
ever since, without giving rise to any inconvenience until 
recently. A few weeks ago the scalp over the embedded 
foreign body was bruised, and since that time it has caused 
irritation and pain. The piece of glass could be readily 
outlined by palpation. On the day mentioned, without anes- 
thesia, a straight incision parallel to the long axis of the 
foreign body was made. No suppuration within or outside of 
the capsule. The piece of glass was found surrounded by a 
flrm capsule of fibrous tisue and measured two centimeters in 
length and two tenths of a centimeter square at the end. The 
broken surface was irregular in outline. The wound was 
sutured with horsehair and union was found complete at the 
time of his discharge, September 11. 

Case i5.— Sergt. Oscar F. Winter, age 52, Company F, 
Ninth Infantry, seventeen years in service. On July 2, while 



195 

in the act of rising just behind the trenches, he was wounded 
by the bursting of a shell near him. He was confident at the 
time, from the sensation experienced, that he had received a 
blow from a large fragment of shell on the crest of the left 
ilium. He says a large ecchymosis formed at once and he 
could see no evidence of penetration. He was assured by a 
medical officer that he had suffered a contusion only, that 
there had been no penetration. He says, however, on being 
questioned, that a small rent existed in the clothing over the 
supposed contusion, but is very positive that he must have 
been struck by the convex side of a large piece of the burst- 
ing shell. An abscess developed soon after the injury was 
received and has discharged at a point near the anterior 
superior spine of the ilium and the resulting sinus has 
remained since. The patient has done duty without missing 
a day since he received the wound, until reaching Camp 
Wikoff. The existence of an abscess cavity and the history of 
an opening in the clothing led to exploration for a foreign body. 
The existing opening was slightly enlarged, under chloroform 
anesthesia, and exploration of the cavity with the finger located 
a shrapnell ball at about ^% inches downward from the open- 
ing of the sinus. Counter-opening was made at.this point and 
the ball extracted. Tubular drainage, irrigation with peroxid 
of hydrogen and 2}^' per cent, carbolic solutions and moist car- 
bolic dressing. Speedy healing of the wounds. 

ABSCESSES. 

We would naturally take it for granted that among the re- 
turning soldiers from Cuba, owing to their greatly debilitated 
condition, suppurative affections in different forms, and affec- 
ting various tissues and organs, would furnish a rich and inter- 
esting material for the surgical ward of the General Hospital. 
The sources of mfection were many, and the resistance of the 
tissues to pathogenic microbes in most of the men who returned 
was at low ebb. A good share of the surgical work consisted 
in incising and draining abscesses, some of them of enormous 
size. In the treatment of all of these cases, owing to the pro- 
nounced anemia and great weakness, special precautions were 
resorted to to prevent the loss of even as much as a teaspoon- 
f ul of blood in performing the operations. In abscesses in the 
anal region the Paquelin cautery was usually used in prefer- 
ence to the knife, in laying open the abscess cavity. In other 
regions the abscess was opened by making an incision through 
the skin and underlying fascia large enough to admit the tip 
of the little finger, when the remaining tissues were tunneled 



196 

with a pair of curved, rather sharp pointed forceps, and the 
tubular wound enlarged to the requisite extent by expanding 
the blades of the forceps during the withdrawal of the instru- 
ment. In most instances a counter-opening was made by 
plunging the forceps into the abscess cavity, inserted into the 
first opening, through the tissues from within outward until 
the tip of the instrument made a cone of the skin which was 
then incised, not over, but on the side of the instrument, suffi- 
ciently to permit the easy escape of the instrument when the 
canal was enlarged by expanding the blades, after which the 
end of the drain was grasped transversly and by withdrawing 
the instrument through drainage was established. The drains 
used were freely fenestrated, the openings being numerous, but 
never larger than to correspond in size to one-fourth of the cir- 
cumference of the tube. The opening and counter-opening 
were made in places where drainage and irrigation would prove 
most efficient. In several cases in which the counter-opening 
could not be made by the use of the forceps, the abscess was 
opened in the usual way, and after evacuation of its contents 
peroxid of hydrogen was injected until the cavity was well dis- 
tended, when the second opening was made in the same way 
as the first. After opening and draining the abscess, irriga- 
tion with a 2^{ per cent, solution of carbolic acid, followed by 
peroxid of hydrogen, and finally again with the carbolized 
solution. In all abscess cases the dressing consisted of a com- 
press of gauze wrung out of a 2^:^ per cent, solution of carbolic 
acid, over which oiled silk was applied with absorbent cotton 
around its edges, to act as a filter, and the whole confined in 
place by a well-applied bandage. In the more serious cases 
the dressing was removed, the abscess cavity fiushed, and a 
new compress applied twice daily. Whenever it was deemed 
necessary, the affected limb was immobilized. This treatment 
proved uniformly successful in preventing profuse suppuration 
and was always followed by rapid improvement in the general 
condition of the patient. 

In the medical treatment of these cases quinin was used 
freely, as well as alcoholic stimulants. Iron preparations and 
a nutritious diet proved most effectual in improving the con- 
dition of the impoverished blood and in restoring normal 
nutrition. 



197 



CONNECTIVE TISSUE ABSCESSES. 

The connective tissue was the tissue most frequently 
the primary or secondary seat of infection. The phlegmo- 
nous inflammation which led to connective tissue abscesses 
occurred almost exclusively in men whose general health 
was shattered. As a rule the patients suffering from 
this affection presented an anemic, almost waxy appear- 
ance and were greatly emaciated. The deterioration of 
health was due to antecedent causes, malaria, yellow fever, 
dysentery, diarrhea, exposure and improper or insufficient food. 
The phlegmonous inflammation in most instances pursued a 
rather insidious process and was clinically not characterized 
by the complexus of symptoms which ordinarily accompany 
the inflammation preceding an acute abscess. The pain was 
often slight, tenderness moderate, and the skin seldom showed 
the inflammatory blush which so constantly is seen during the 
development of an acute subcutaneous abscess. A tendency 
to burrowing was manifest in most cases. The induration of 
the abscess wall, so common in acute abscess, was lacking in 
most of our cases. There seemed to be a total absence of a 
tendency to the limitation of the area of abscess formation. 
The cases that came under our observation resembled in their 
symptomatology, pathology and clinical course very closely 
abscess formation as seen during the latter course of any pro- 
longed acute infective disease, or during convalescence from 
such. In opening these abscesses I was always careful to 
make the openings some distance from the center of the ab- 
scess cavity, in preference at its margins, and the same loca- 
tion was selected in case a counter-opening was made. By fol- 
lowing this method of incising and draining the abscess the 
skin over the center of the abscess, damaged to the greatest 
extent by the underlying phlegmonous process was avoided, 
and complete evacuation and free drainage secured. The 
same careful preparations were made for the operation as in 
cases requiring surgical intervention for aseptic conditions, 
with a view of guarding against secondary infection. 

Under this treatment, the general and local conditions of the 
patients improved very rapidly. In abscesses of very large di- 
mensions from two to four incisions were made and as many 
points of drainage established. As suppuration ceased and the 



198 

abscess cavity commenced to shrink, the drains were shortened 
from time to time to enable the process of healing to proceed 
without hindrance from mechanical causes. 

Case 14. — Robert Bloedel, age 25, Third Infantry Band, 
enlisted fifteen months ago. Had chills and fever in Cuba for 
about a month, followed by dysentery. Is still suffering from 
the diarrhea which followed the dysentery and the patient is 
much emaciated and very anemic. Before going to Cuba he 
noticed a small pimple on his neck. Just before leaving San- 
tiago, swelling of the neck began in the connective tissue, at 
the site of the pimple, and has progressed steadily. Examina- 
tion of the cavity of the mouth does not reveal a source of 
infection. There can be but little doubt that the minute 
furuncle, which proved harmless as long as the patient re- 
mained in good health, became the focus of infection of the 
underlying connective tissue which was made more susceptible 
to infection by the effects of disease. A large fluctuating 
swelling in the neck, just below the angle of the jaw, marks 
the location and extent of the connective tissue abscess. Pain 
has never been severe. Edema, but no redness of skin. All 
of the local symptoms indicate a slow, subacute inflammation 
of the deep connective tissue. The patient was etherized and 
through drainage was established, the drainage tube being 
placed in an oblique direction from the floor of the abscess to 
a point opposite and behind. A large quantity of creamy pus 
was evacuated and the cavity thoroughly washed out with car- 
bolized solution and peroxid of hydrogen. A large moist anti- 
septic compress covered with oiled silk was applied and held in 
place by a bandage. Very little suppuration after operation, 
speedy healing of the abscess cavity accompanied by a marked 
improvement in the appearance of the patient. 

Case 15. — P. P. Sprague, age 29, Seventh Infantry, Company 
I, entered the regular service seven months ago. He landed in 
Cuba July 10. Contracted malaria, lost flesh and strength, 
but continued to perform his usual duties. About three weeks 
ago he experienced a sense of soreness in the calf of his right 
leg in the region of a scar from an injury received during child- 
hood. The soreness increased slowly in severity, and for a 
number of days he has suffered from a throbbing pain suffi- 
ciently severe to prevent sleep. The patient is much enfeebled 
from the effects of the previous disease, aggravated by the 
recent attack of phlegmonous inflammation. No local source 
of infection could be found on the most careful search. It is 
very probable that the scar tissue furnished the locus minoris 
resistentice which determined localization of pus microbes 
floating in the general circulation sufficient in number and 
virulence to give rise to a subacute phlegmonous process. The 
whole leg is swollen from the ankle to the knee, tense and 
edematous, a circumscribed inflammatory blush over the 



199 

lower portion of the gastrocaemius muscle. Fluctuation 
deep- seated, somewhat obscure and diffuse. 

The diagnosis made at the time, was deep-seated phlegmonous 
abscess, involving the connective tissues between the deep- 
seated muscles of the leg. August 29, under ether unesthesia 
the abscess was opened by an incision over the posterior aspect 
of the leg in the median line, at a point where the muscle ter- 
minates in tendon ; a large quantity of thin bloody pus escaped. 
As it was found impossible to make a counter-opening in the 
upper recess of the abscess cavity by the use of forceps, per- 
oxid of hydrogen was injected through the opening to distend 
the abscess cavity sufficiently to facilitate incision from with- 
out. The second incision was made in the usual way over the 
upper third of the fibula and a counter- opening established on 
the tibial side, effecting in this manner efficient through drain- 
age below and from side to side. Digital exploration through 
the three openings located the abscess correctly anatomically. 
In exploring the interior of the abscess the tibia and fibula 
could be distinctly felt. The abscess cavity was disinfected in 
the usual way and after applying the wet antiseptic compress, 
the patient was returned to his cot and the limb placed in an 
elevated position. The final recovery of the patient was 
retarded by several severe attacks of malaria during one of 
which the mercury reached 106 F. The chills and fever yielded 
to large doses of quinin. 

Case 16. — Henry H. Mix, age 21, Third Infantry, Company 
F, enlisted three months ago. On June 6 last, while on parade 
had an attack of heat exhaustion followed by diarrhea for sev- 
eral days. At Tampa, June 8, two days later, he was put on 
sick list for two furuncles behind the left knee. These healed 
promply. July 10 on reaching Cuba, he suffered from furun- 
cles on buttocks, also malarial fever and diarrhea. At this 
time an abscess formed in the right popliteal space, which pur- 
sued an insidious, chronic course. At the time the patient 
reached Montauk, he was very anemic and almost reduced to a 
skeleton, and the abscess had opened at different points. The 
subcutaneous tissue was extensively undermined, and through 
the openings the fungous lining of the cavity could be distinctly- 
seen. Ths abscess cavity discharged profusely and extended 
from the middle of the thigh to the upper portion of the calf 
of the leg. August 29, the sinuses were enlarged, a number of 
counter-openings made and free tubular drainage established. 
The abscess cavity was thoroughly disinfected and a large moist 
antiseptic compress applied. As there was some tendency to 
contraction of the knee joint, the limb was placed in a straight 
position and immobilized by the use of a well padded anterior 
wire splint so applied that the abscess could be exposed audi 
treated without disturbing the limb. Malarial fever, which 
developed on the second day after the operation, retarded the 
healing process, and for a few days threatened the life of the 



200 

patient. After the fever was under control by the administra- 
tion of large doses of quinin, a satisfactory process of repair set 
in, which soon effected healing of the abscess and restoration 
of tisssues lost by the extensive destructive process. 

Case 17. — Joseph McGuire, Ninth Massachusetts Volunteers, 
Company C, had some febrile attack in Cuba, the nature of 
which is not known. He was admitted to the surgical depart- 
ment of the General Hospital, September 7, suffering from a 
superficial connective tissue abscess over left triceps about two 
inches below the shoulder joint. He has at the same time an 
alveolar abscess which is discharging through a carious tooth. 
The infection in this case evidently took place from the blood, as 
there are no traces of the existence of a local infection atrium 
to which the phlegmonous process could be attributed. 
Through drainage and moist carbolized dressing. 

Case 18, — James F. Dite, age 21, First Illinois Infantry, 
Company H, received a severe contusion of anterior surface of 
right thigh from falling log near Santiago. He was treated by 
a Cuban doctor for rheumatism, and then sent to the Division 
Hospital where a swelling which had formed at the site of in- 
jury was incised, but no pus escaped. The swelling remained, 
and gradually increased in size. When admitted to the surgi- 
cal ward his general health was precarious. Marked anemia 
and emaciation. The anterior aspect of the affected thigh 
from near the knee to the inguinal fold was the seat of a fluc- 
tuating swelling. The center of the swelling was occupied by 
a small granulating area marking the place where the incision 
was made. The abscess was underneath the quadriceps femo- 
ris muscle, and evidently the incision had not been made deep 
enough to reach the pus. As the skin was not broken by the 
injury, infection was determined by microbes floating in the 
circulation and their localization and growth in the contused 
deep connective tissue. Under anesthesia the abscess was 
opened at the most dependent point and a counter opening 
made on the opposite side with the aid of distension of the cav- 
ity by peroxid of hydrogen injection. Through drainage and 
thorough disinfection of the interior of the abscess cavity 
completed the operation. Prompt relief and improvement fol- 
lowed the operative intervention. 

Case 19. — Dennis Riley, age 21, First District of Columbia 
Infantry, Company E, after passing through a rather severe 
attack of typhoid fever was admitted to the surgical ward 
suffering from multiple abscesses, varying in size from that of 
a pea to a walnut, involving the face and the neck. The largest 
abscess was above the left eyelid. All of these abscesses had 
their primary starting point in the subcutaneous connective 
tissue. Treatment by incision and drainage. Convalescence 
progressed without any further interruption. The location of 
these abscesses on the exposed part of the body would indicate 
that the infection had a local source, probably slight abrasions 



201 

inflicted by the patient himself during the course of the 
fever. 

Case 20. — Edwin Stockwell, aged 28, Second Infantry, Com- 
pany I, was well until the day before leaving Cuba, August 10 ; 
on that day felt very weak and sick. On boarding transport had 
to lie down, vomited, then felt better for a time, then weak 
and sick and nausea and vomiting again. He was feverish all 
the time and slightly jaundiced, but contioued on duty with 
the sick. Some doubt remains as to whether this attack was a 
mild form of yellow fever or malaria. Since his arrival here 
he has done duty as a nurse. Five or six days ago a furuncle 
developed on the middle of the posterior aspect of the right 
thigh, below the gluteal fold. This opened and discharged 
slightly, but the swelling has continued to increase in size. 
On examination, a crater-like defect in the skin marks the site 
of the primary focus of infection. From this point a red zone 
of inflammation extends in all directions equally to a distance 
of two inches. The phlegmonous progressive connective tissue 
inflammation had its origin from the furuncle. Such a compli- 
cation would probably not have occurred if the patient's gen- 
eral health and power of resistance tD general infection had 
not been impaired by the antecedent attack of fever. The 
skin around the furuncle was extensively undermined. The 
cavity was freely laid open by a vertical incision and the 
necrosed tissue and infectived granulations scraped out with a 
sharp spoon, and after thorough disinfection was lightly packed 
with a strip of iodoform gauze, and a large moist compress 
applied. 

Case 21.— John A. Johnson, aged 24, Third Infantry, Com- 
pany H, enlisted eight months ago. Phlegmonous inflamma- 
tion of middle finger of left hand. Three weeks agfo had an 
attack of malarial fever in Cuba, which was complicated by 
diarrhea. He was treated four days in one of the hospitals, 
when he returned to his command for duty. The fever left 
him in a weakened condition. Ten days ago on leaving San- 
tiago, he noticed a soreness over the dorsal side of the middle 
finger of the left hand directly over the middle joint. Cause 
of infection not known. An acute superficial abscess formed, 
attended by great pain until it ruptured. A considerable por- 
tion of the overlying skin sloughed, leaving a ragged surface 
with edematous red margins. On August 27, the patient was 
placed under an anesthetic, when a thorough examination 
showed that the infective process did not extend to the joint 
or the extensor tendon. With sharp spoon, scissors and for- 
ceps the infected tissues were removed, the resulting surface 
disinfected and packed with iodoform gauze and the finger 
immobilized on a palmar splint. The wound healed promptly 
and the prospects are that the finger will regain its normal 
functions. 

Case 22. — Richter, aged 23, First Illinois Infantry, Company 



202 

D, contracted typhoid fever in Cuba five weeks ago. Durins: 
the fever a copious herpetic eruption made its appearance on 
the upper lip and about the nasal orifices. The fever left him 
in a greatly emaciated condition. A swelling formed in the 
left cheek duriog the last three or four days and increased 
rapidly in size. Pain and tenderness not well marked. The 
patient sought medical treatment at the surgical ward Sun- 
day, September 11. The left cheek was the seat of a large 
fluctuating swelling. Diagnosis made at the time — abscess of 
cheek. The abscess was incised from the mouth and a large 
quantity of very offensive pus was evacuated. The patient was 
directed to resort to frequent rinsings of the mouth with a 
saturated solution of boracic acid and was given a furlough to 
enable him to return as quickly as possible to his home. Infec- 
tion in this case undoubtedly occurred through the skin defects 
left by the herpetic eruption. 

GLANDULAR ABSCESS. 

In the discussion of phlegmonous abscess, infection was 
traced either to a portio invasionis or local conditions, which 
determined localization from local causes, in cases in which it 
was reasonable to suppose that the essential cause of infection 
existed in the general circulation. Without calling attention to 
the fact, it is reasonable to suppose that in the first class of 
patients the essential microbic cause reached the tissues 
through the connective tissue spaces, that is, that a direct 
anatomic connection existed between the primary essential 
infection-atrium and the seat of secondary phlegmonous man- 
ifestations. In the consideration of glandular infection it is 
essential to connect the infection-atrium anatomically and 
physiologically, with the secondary glandular suppurative con- 
ditions. We are able from the clinical history and the patho- 
logic conditicns presented in most of the cases to establish such 
a direct connection between the primary source of infection 
and the secondary glandular manifestations. I have reason to 
believe that in most of these cases the essential cause of infec- 
tion was the streptococcus pyogenes, because it is well known 
that this pyogenic agent usually follows either the connective 
tissue spaces or the lymphatic channels in giving rise to a dis- 
tant infective suppurative process. 

Case 25.— Patrick Collins, age 28, Company C, Eighth In- 
fantry, enlisted one year ago. About the middle of July, while 
in Cuba, had a malarial chill followed by fever. Has had fever 
and diarrhea, and has been on the sick list ever since. While 
returning on transport from Cuba he experienced soreness in 



203 

the region of the left parotid ^land ; this symptom has been 
followed by the usual clinical evidences indicative of the exist- 
ence of an abscess in that locality. On August 29 he presented 
himself at the surgical ward, and at that time it was not diffi- 
cult to diagnosticate the existence of a large abscess in the 
region of the parotid gland. At that time, under ether anes- 
thesia, it was easy to recognize a diffuse abscess in the parotid 
region. It was more difficult to decide whether this abscess 
was of malarial or typhoid origin. Two incisions were made, 
an extensive purulent product was evacuated, and efficient 
through tubular drainage was established. In this instance the 
whole gland seemed to be surrounded by the suppurative prod- 
ucts and the through drain was passed underneath the gland 
that was the primary seat of the secondary field of infection. 
The patient improved rapidly after the operation. 

Case 24,— John Williams, age 25, Ninth Cavalry, Troop 
P., colored, enlisted four months ago. Following a strain in 
lifting and exposure in rough weather, while on duty in the 
Gamp at Tampa, Fla., he became aware of the enlargement of 
the inguinal glands on the right side. The glands were very 
painful when he was on active duty. There are no evidences 
of general infection of any kind and the most scrutinizing ex- 
amination failed to detect any tangible source of infection in 
the distal side of the lymphatic circulation. On palpating, 
three or four ioguical glands were found distinctly enlarged 
with plain evidences of beginning perilymphadenitis, but no 
distinct abscess formation. On August 22 chloroform was ad- 
ministered and a curved incision made, with the convexity di- 
rected upward in such a manner as to expose the infected 
glands freely. The glands, three in number, honeycombed 
with pus were enucleated. A place for drainage was estab- 
lished, the wound thoroughly disinfected with iodoform, xvhen 
the external incision was closed with sutures of horsehair. 
The wound healed promptly by primary intention. 

Case 25. — George A. Roberts, Sixteenth Infantry, Gompany 
H., colored, was ill eight days with malaria in Guba, was af- 
ter that on duty until his arrival in Montauk, when he again 
had malarial fever. During this attack a furuncle devel- 
oped on calf of the right leg and opened spontaneously. From 
this point a lymphadenitis started, which extends to the deep 
lymphatic glands in Scarpa's triangle and terminated in a 
lymphadenitis and perilymphadenitis. The lymphatic glands 
in this region, being in a state of inflammation, 
resulted in the formation of a tender and painful 
swelling four inches in length and about three inches 
in width. No fluctuation and no inflammatory discoloration 
of the skin. The patient was confined to his cot with the af- 
fected limb in an elevated position. A large compress satur- 
ated with 2% per cent, hot solutionof carbolic acid. Applied 
Gred6' s silver ointment to be rubbed into the skin over the swell- 



204 

iDg ODce a day. Under this treatment the inflammatory process 
subsided and the prospects are, that the swelling will disap- 
pear without pus formation. 

Case 26. — Frederick Warner, age 37, colored, Ninth Cav- 
alry, Troop L, contracted chancroid about six weeks ago, while 
on duty at Tampa. The lymphatic glands in the inguinal 
region became infected and the suppurative lymphadenitis 
terminated in the formation of three glandular abscesses, 
which opened spontaneously. At the time the patient was 
operated upon, September 1, three fistulous openings were 
found, and the connective tissue was extensively infiltrated. 
No scars or other evidences of the primary lesion can be de- 
tected. It was plainly a case of suppurative lymphadenitis, 
caused by invasion with pus microbes from the external geni- 
tals. Under chloroform anesthesia the sinuses were enlarged, 
and the remaining broken down gland tissue and infected gran- 
ulations removed by a vigorous use of the sharp spoon. The 
resulting wound was thoroughly disinfected, iodoformized and 
packed with iodoform gauze and covered with a large moist 
antiseptic compress of gauze, over which was placed an over- 
lapping piece of oiled silk, and the whole dressing held in 
place by a bandage embracing the pelvis and upper part of 
thigh. The patient left the hospital a week after the opera- 
tion, at which time the abscess cavities were much diminished 
in size and lined by vigorous healthy granulations. 

Case 27. — John H. Butler, age 21, Ninth Cavalry, Troop L, 
colored. Tubercular lymphadenitis of submaxillary gland. 
Family history negative. Mother and father living ; two chil- 
dren died in infancy ; rest living and in good health. About 
two months ago began to have pain in right side of neck and 
submaxillary region, and then noticed a small, hard swelling 
below the angle of the jaw. Additional glands in the same 
region became involved. At the time he entered the surgical 
ward a large glandular mass, composed of several enlarged 
lymphatic glands, was found in the right submaxillary region. 
On palpation the swelling was painful, but no distinct fluctua- 
tion could be felt. Inspection of the mouth failed to reveal 
anything which could be regarded as an infection-atrium. The 
tubercular nature of the glandular affection was recognized, 
and a radical operation for the removal of the glands was per- 
formed September 6, the patient being under the influence of 
chloroform. The glandular mass was freely exposed by a 
semilunar incision with the convexity downward and by reflec- 
tion of the cutaneous flap in an upward direction. The whole 
mass was dissected out in one piece, which included not only 
the tubercular glands, but likewise the infiltrated connective 
tissue surrounding them. The submaxillary gland was ex- 
posed, and during the latter part of the operation it became 
necessary to cut and ligate the facial artery. The gland tissue 
throughout had undergone coagulation necrosis ; each gland 



205 

contained several foci of caseation. The wound was iodo- 
formized and sutured throughout with horse- hair, provision 
for gauze drainage having been made by making a button-hole 
near the margin and center of the flap. Healing by primary 
intention. 

Case m— Schuyler C. Black, age 31, Ninth Cavalry, Troop 
I, colored, enlisted four months ago. Chronic balanitis and 
bilateral plastic lymphadenitis of inguinal glands. In June last 
noticed enlargement of inguinal glands on both sides, follow- 
ing a small sore on the glans penis near the corona. He was 
treated for primary syphilis, and was given large doses of 
potassic iodid. At no time was there any induration at the 
base of the sore, which always presented the appearance of an 
abrasion rather than an ulcer. At no time have there been any 
indications of secondary syphilis. The lymphatic glands in 
other regions of the body are normal. The patient states that 
the sore has healed repeatedly, reappearing at varying inter- 
vals in the same place. Examination of the penis reveals 
slight phimosis, chronic balanitis which has resulted in great 
thickening of the mucosa lining the prepuce. The sore, which 
has been a source of great mental distress to the patient, ap- 
pears in the form of a very superficial abrasion not larger than 
a split pea with ill defined margins and no induration whatever 
at its base. Recently the preputial margin became the seat 
of a herpetic eruption. The lymphatic glands in both groins 
are hard, not very tender to the touch and vary in size from 
that of a pea to a hazelnut. September 13, typical circumci- 
sion was performed under chloroform narcosis. It is expected 
that the removal of the direct cause of the lymphadenitis will 
be followed by a speedy reduction in the size of the glands. 
The essential cause is to be attributed to the entrance of pus 
microbes into the lymph channels from the local lesions of the 
glans penis and prepuce which became arrested in the lym- 
phatic filters, producing an inflammation which came to a 
standstill short of suppuration. 

Case -^5.— Robert V. Smith, age 21, Tenth Cavalry, Troop 
E, colored, enlisted June 20. A month ago while in camp in 
Florida, he noticed a number of small pimples on the scalp on 
the right side. These small furuncles still exist, and a week 
ago gave rise to a deep seated lymphadenitis affecting the 
lymphatic glands in the superior posterior triangle on the cor- 
responding side of the neck. When the patient came under 
observation, September 13, a large and somewhat diffuse swell- 
ing marked the location of the infected glands ; evidently the 
connective tissue around and between the glands is secondarily 
implicated in the inflammatory process. The swelling is hard 
and tender on pressure. No signs of central softening. 
Evening temperature 102 F., morning temperature 100 F. Di- 
rections were given to clip the hair short, and to disinfect the 
entire scalp. Crede's silver ointment to be rubbed into the 



206 

skin over the swelliDgacd to apply a hot, moist antiseptic com- 
press. The patient is anemic, for which condition Gude's 
pepto-mangan was prescribed. There is some prospect that 
the removal of the source of infection and the local applications 
will succeed in arresting the process and in effecting resorption 
of the inflammatory product. 

This hope was not realized, as a few days later, September 23, 
distinct fluctuation was felt and the abscess was incised and 
drained, the patient being under the influence of chloroform. 
Rapid improvement followed the operation. 

ABSCESS FOLLOWING TYPHOID FEVER. 

It is somewhat singular that among the hundreds of cases of 
typhoid fever, that I had an opportunity to see and examine in 
Porto Rico and in this great national camp, no cases of perfor- 
ation have come to my notice. I kept myself in readiness to 
perform laparotomy at a moment's notice, but my services were 
never requested for this particular purpose. I have no doubt 
but that some of the deaths from typhoid fever were due to this 
cause, and that this fatal complication was either overlooked or 
the general condition of the patient was so grave when it oc- 
curred, that the attending physicians did not deem it advisable 
to send for the surgeon. In this camp we had all the necessary 
facilities for abdominal operations, and I was hopeful that I 
should have an opportunity to give surgery a fair trial in such 
cases, but in this I have been disappointed. The most import- 
ant, and most frequent complications of our typhoid fever pa- 
tients have been bedsores and abscesses. The careful and at- 
tentive nursing our patients here have received, has done 
much in reducing the mortality and suffering from decubitus. 
Frequent washing with alcohol of the parts exposed to decu- 
bitus and the use of rubber pillows, and in the worst cases, of 
water or air beds, have contributed much in the prevention 
and successful treatment of this complication. We have had 
however, an excellent opportunity to study the etiology and 
pathology of abscesses as a complication of typhoid fever. The 
material was abundant and interesting. It is a source of 
regret to me that we did not have at our disposal a well-equip- 
ped bacteriologic laboratory to enable us to study in a rnore sat- 
isfactory manner the contents of those abscesses. Acting As- 
sistant-Surgeon Ewing brought his own microscopic outfit, in- 
cluding the different stains, and did good work in the micro- 
scopic examination of pus and other pathologic products, but 



207 



we had no facilities for making cultures. He examined the 
contents of three abscesses in as many patients, and found as 
the essential bacteriologic cause the bacillus of typhoid in one 
and the ordinary pus microbes in the remaining two cases. 

The typhoid or so-called metastatic abscesses are caused 
by the bacillus of typhoid fever or by pus microbes which find 
their way into the circulation through some infection- atrium, 
especially the intestinal ulcers, as the result of a mixed infec- 
tion. I have no doubt that in some cases the colon bacillus 
finds its way into the general circulation and produces the 
same results. The only case of bone and joint infection that 
came under my observation, and that could be brought in con- 
nection with the typhoid infection occurred in the case of a 
young soldier recovering from a severe attack of typhoid fever. 

Case 30. — William Fairweather, age 22, Company A, Twelfth 
Infantry, about one week after the surrender of Santiago, 
was attacked with fever which continued for three weeks. He 
reached this camp with his regiment, emaciated to a skeleton, 
and extremely anemic. A week ago, while moving about, he 
was attacked rather suddenly with a severe pain in the right 
sacro-iliac synchondrosis and extending to the leg on the same 
side. The pain in the leg subsided after a few days but in- 
creased in severity at the point where it first commenced. The 
pain is of a dull, aching, throbbing character. Slight swelling 
over and in the line of the joint. Evening temperature one de- 
gree above normal. No redness or edema of the skin. Septem- 
ber 6, the joint was punctured with the largest needle of an 
exploring syringe and a 5 per cent, solution of carbolic acid 
was injected in different directions, so as to reach the infected 
tissues as far as possible. No diflSculty was met with in inject- 
ing three drachms of the solution. The needle puncture 
was sealed with collodium and a pledget of cotton. Marked 
improvement followed the intra articular and parenchymatous 
injection. The pain and tenderness had nearly disappeared on 
the third day. Under tonics and stimulants the general con- 
dition of the patient improved from day to day. There is no 
reason to fear at this time that suppuration will take place. 

This case represents one of those rare complications of 
typhoid fever in which a joint becomes the seat of secondary 
infection during the latter stages of typhoid fever or during 
convalescence, in which the inflammatory process often results 
in great destruction of tissue without pus formation. Whether 
or not the injection should be credited with having brought 
about the speedy cessation of active symptoms can not be de- 



208 

cided, either way with any degree of positiveness. I have 
learned to value the therapeutic effect of patenchymatoue in- 
jections of carbolic acid in the treatment of chronic or suba- 
cute inflammation of a non tubercular inflammation, and I am 
inclined to attribute to it in this particular and similar cases 
positive curative properties, the evidence of which in this case 
appeared so shortly after it was made. 

Case 31,— C H. Baker, aged 22, Company F, Second Massa- 
chusetts Infantry, was sick two months in Cuba with fever, 
malaria, headache, aaiorexia, diarrhea, in consequence of which 
he became very weak. Shortly after boarding the transport, 
he became delirious and has been sick with typhoid fever for 
three weeks. A week ago, while convalescent, he was attacked 
suddenly with violent pain in the right testicle which rapidly 
increased in size, reaching the dimensions of a small orange in 
the course of two days. At that time, the temperature in- 
creased two degrees above normal. On the third day after the 
attack, the swelling was hard, very sensitive to the touch, the 
skin red and glossy. No chills. Under applications of lead 
water and opium the pain has been somewhat mitigated and 
the swelling slightly diminished in size. September 10, a week 
after the complication had set in, the patient was transferred 
to the surgical ward. At this time deep-seated fluctuation could 
be distinctly felt over the center of the swelling. Lees discol- 
oration of the skin than a few days ago. Swelling only about 
twice the size of the normal testicle. The abscess appears to 
occupy the center of the testicle. Under ether anesthesia the 
abscess cavity was opened at the most dependent point, and a 
counter-opening two inches higher up made by tunnelling the 
tissues from within outward with a curved hemostatic forceps, 
and through drainage established. The pus was of the con- 
sistence of cream and whitish in color. No transudation into 
the tunica vaginalis. The conditions revealed at the time of 
operation left no doubt regarding the parenchymatous central 
origin of the abscess. Microscopic examination of the pus 
removed showed typhoid bacilli in great abundance as the ex- 
clusive bacteriologic cause of the suppurative orchitis. The 
patient improved very rapidly after the operation, and was 
transferred in less than a week to one of the Boston city 
hospitals. 

Case 32. — L. Gardner, age 38,- Company A, Sixth Infantry, 
went through the Cuban campaign with two days' slight ill- 
ness. He lost flesh, but felt well until he came on the trans- 
port four weeks ago, when he was attacked with fever which 
proved to be typhoid complicated by malaria as shown by the 
erratic temperature curves. Convalescence was preceded by 
inflammation of the left parotid gland. Emaciation marked. 
Spleen much enlarged. The liver dulness extends from the 



209 

sixth rib to an inch below the costal arch. Lungs normal. 
Heart sounds clear and distinct. Pulse strong and regular. 
Tongue red and glazed. A week after the beginning of the at- 
tack, a large abscess had formed and fluctuation could be dis- 
tinctly felt, extending from a level with the external meatus to 
near the angle of the jaw. At that time, September 7, 
the patient was etherized, the abscess opened at the lowest 
and highest points, and through drainage established, a 
large quantity of thick purulent, curdy pus escaped. The 
cavity was washed out with a 2.5 per cent, carbolic solution 
and peroxid of hydrogen, and a large, moist, hot antiseptic 
compress applied. Improvement followed at once and ended 
in a slow recovery without any interruptions. 

Case 33. — Patrick Collins, age 26, Eighth Infantry, Company 
C, has been in the service one year. About two weeks after 
the fight in Cuba was attacked with malaria, which was fol- 
lowed by typhoid. The fever has persisted since, attended by 
diarrhea and other symptoms indicating its nature. While on 
the transport on his return he complained of a sense of sore- 
ness in the left parotid region, followed by swelling and red- 
ness. Patient much emaciated and very feeble. At the time 
the operation was performed, August 29, the swelling extended 
from the external ear to near the angle of the jaw, and deep- 
seated fluctuation was distinct. Incision, drainage, disinfec- 
tion and after-treatment the same as in the preceding case. 
Owing to the marked weakness of the heart's action, the pa- 
tient was given two ounces of whisky before he was placed 
under the influence of ether. Alcoholic stimulants were admin- 
istered in large and frequently repeated doses and acted very 
promptly in increasing the tone of the circulation and in build- 
ing up the impaired nutrition. The discharge from the abscess 
in this, as well as the other cases of abscess of the parotid fol- 
lowing typhoid fever, was very slight after the evacuation of 
the abscess contents. 

Case 34. — Harold Robinson, age 28, Third Infantry, Com- 
pany D, contracted typhoid fever in Cuba. He is now in the 
third week of the fever and has been delirious most of the 
time. The disease pursued almost from the beginning a very 
malignant course. About five days ago a swelling was detected 
in the region of the right parotid gland, which increased very 
rapidly in size, involving the skin after two or three days. The 
abscess ruptured on the fourth day into the external meatus, 
but evacuation was incomplete on account of the existence of 
several separate compartments in the abscess cavity, which 
were discovered at the time the operation was performed. The 
abdomen is intensely tympanitic, the skin of feet, legs and 
abdomen spotted with dark points of ecchymosis. The con- 
dition of the patient was critical when the operation was 
performed, September 10. The operation had to be performed 
without an anesthetic and in his ward, as he was too feeble to 



210 

justify his transfer to the surgical ward. The impoverished 
condition of the blood made it necessary to make the incision 
only thpough the skin, completing the opening with hemostatic 
forceps. Free tubular drainage was established and the abscess 
cavity was treated in the usual way. Strychnia and alcoholic 
stimulants were administered freely, but the heart failed to 
respond and the patient died the next day. Notwithstanding 
that the openings were made largely by the use of blunt instru- 
ments, free oozing of blood followed the operation, which may 
have contributed in hastening the fatal termination. 

Case 55.— Giles Potter, age 33, Second Massachusetts Infan- 
try, had chills and fever while in Cuba, but was on duty con- 
tinuously. Was still weak and ill when he came on board the 
transport. The parotid abscess began on transport. He is 
very weak and emaciated, at times delirious ; temperature in- 
dicates typhoid fever. Conjunctivae slightly jaundiced. Pulse 
small and thready. Spleen slightly enlarged. The abscess 
was incised and drained without the use of an anesthetic, in 
its stead a large dose of whisky was given. The pus in this 
case was of a green color. Patient improved rapidly after the 
operation and is now on the way to convalescence. 

Case 56'.— John Simpson, age 28, Troop K, First Cavalry, 
was admitted to the general hospital August 25, suffering from 
typhoid fever, with a temperature gradually declining until 
September i, when it rose suddenly from 99.4 to 102 and 103, 
dropping on the 8th to 99. On admission patient had very 
marked roseolar eruption on abdomen and limbs. During the 
course of the fever numerous furuncles appeared on the fore- 
head and back. Delirium has been a prominent feature in the 
case almost from the beginning. Directly following the sud- 
den rise of temperature on September 4, soreness and swelling 
of the right submaxillary gland were noticed. Today, Sep- 
tember 10, a fluctuating swelling, the size of a small apple, 
marks the location and size of the abscess. Operation without 
anesthetic. Incision, counteropening, tubular drainage, irri- 
gation with peroxid and carbolic solution, wet carbolic dress- 
ing. Rapid improvement followed the operation and the 
patient is now, September 13, fairly convalescent ; abscess 
nearly healed. 

The parotid gland, of all glandular organs, is the most fre- 
quent seat of secondary infection in typhoid fever. For 
reasons that remain unexplained the submaxillary is seldom 
involved, and the sublingual is still more rarely affected. The 
infective process begins in the parenchyma of the salivary 
gland but extends rapidly to the capsule and the surrounding 
connective tissue, leading to a phlegmonous process which in 
four or five days, as a rule, terminates in a well-marked abscess 
with the gland as a central point. The physician must be on 



211 



the alert in such cases, and resort to the use of the knife in a 
most cautious manner as soon as fluctuation can be detected. 
It is advisable to establish through drainage for the purpose 
of securing free evacuation and thorough disinfection of the 
interior of the abscess cavity. The openings should be made 
by cutting only the skin and underlying fascia with the knife, 
completing them by tunnelling the remaining tissues with a 
curved hemostatic forceps. Dry dressings should not be em- 
ployed in such cases ; nothing is more grateful to the patient 
and more efficient in the after-treatment than the application 
of a moist, hot, antiseptic compress covered with oiled silk to 
retain heat and moisture. The safest and most efficient solu- 
tion for this purpose is a saturated solution of acetate of 
aluminium, but when this can not be secured, a 2.5 per cent, 
solution of carbolic acid or a saturated solution of boracic acid 
answer as excellent substitutes. 

In the next case the clinical history is very defective, and it 
is impossible to say with any degree of certainty whether or 
not the parotid abscesses followed in the course of typhoid 
fever, or whether they were external manifestations of a 
general septic process that developed independently of that 
disease. 

Case 37. — Austin Dunlap, age 19, Company H, Third Infan- 
try, was taken suddenly ill in Tampa, about July 1, with pain 
in the back and joints and nausea. The disease was diagnos- 
ticated at the time as malaria. He was sent to quarters, and 
after four days returned to duty. On arrival at this camp, 
August 14, had three severe chills during the first twenty-four 
hours and has been very sick since. When admitted to the 
surgical ward with bilateral suppurative parotitis and large 
bedsores, he was reduced to a skeleton. Extensive herpes 
labialis which near the left angle of the mouth have caused 
ulceration ; abscess over elbow joint. Pulse rapid and very 
small, temperature irregular. When first admitted the case 
was regarded as a forlorn one and whiskey was given in ounce 
doses hourly. The swelling in the parotid region, on both 
sides, was hard and very sensitive to the touch. Credo's sil- 
ver ointment and hot antiseptic compresses constituted the 
local treatment. Five days later distinct fluctuation could be 
detected and one of the parotid abscesses was incised and free 
tubular drainage effected. Owing to his critical condition the 
operations had to be performed without an anesthetic. The 
next day, September 10, the opposite abscess was treated in 
the same manner. The patient has been placed on a water- 



212 

bed and was restless and most of the time delirious. No evi- 
dences of metastasis in any of the internal organs. Under the 
stimulating treatment he rallied promptly and at the present 
time, September 13, his mind is clear and the temperature 
normal. Discharge from abscess cavities slight. The drains 
are shortened from time to time to permit early definitive heal- 
ing of the abscesses. 

I am confident that early operative treatment and the heroic 
employment of alcoholic stimulants have been the principal 
means in saving the life of this patient. 

Case 39. — Corporal George F. Shilling, age 18, Company G, 
First D. C. Volunteers. Enormous typhoid abscess of arm. 
Family history negative. Health excellent before he went to 
Cuba. On August 15 reported sick at the hospital. Had 
been feeling ill for some days. He has been delirious most of 
the time since admission to the General Hospital here. The 
temperature has been on an average 103 degrees F., with 
daily variation of a degree and a half from August 19 to Sep- 
tember 4. Since latter date the temperature at no time has 
been over 101 degrees F. The pulse is small, rapid and weak, 
tongue dry, brown and fissured. On arriving here on trans- 
port there were five large bedsores on back and numerous 
small abscesses of the skin. He was placed at once upon a 
water-bed, but the bedsores continued to still further under- 
mine the skin. Two days ago when the nurse was dressing 
the bedsores, she discovered a swelling of the right arm on the 
outer edge of the biceps muscle. This has rapidly increased 
in size and now presents itself as an enormous abscess extend- 
ing from the shoulder to the tendon of the biceps muscle. 
Fluctuation is most distinct over the outer aspect of the arm. 
On palpation a crackling sensation is felt, and on percussion 
the swelling was distinctly tympanitic. The presence of gas 
in the abscess cavity could not be doubted. September 12 the 
patient was almost pulseless, lips cyanotic, respiration shal- 
low, and marked twitching of the muscles of the upper extremi- 
ties. In the afternoon the abscess was cautiously opened 
above and below and a rubber drainage tube drawn through. 
A large quantity of an offensive gas and creamy pus was evac- 
uated. The abscess cavity was freely irrigated with peroxid of 
hydrogen and 2.5 per cent, of carbolic solution and the moist, 
hot antiseptic compress applied. In place of an anesthetic 
the patient was given an ounce of whiskey, which was to be 
repeated hourly. Hot water bags were applied to relieve the 
embarrassed peripheral circulation. Contrary to our expecta- 
tions, the patient rallied under this treatment and presented a 
much more encouraging condition the next morning, when it 
was reported that the temperature was nearly normal, mind 
clear and the pulse full and strong. Microscopic examination 
of the pus by Dr. Ewing revealed : 1, many cocci resembling 



213 

staphyioccus pyogenes ; 2, a few large capsulated cocci ; 3, a 
few fine slender bacilli staining faintly with methylene blue. 
There is nothing that resembles the bacillus aBrogenes capsula- 
tus. The patient is in a fair way to recovery (September 17). 
Case 40. — Fred Angier, age 23, First Cavalry, Troop I, is un- 
der treatment for typhoid fever probably during the third 
week of his illness. Patient is delirious and it is impossible to 
obtain reliable information as to duration of his sickness. 
Very recently the right eye became affected by an acute in- 
flammatory process which appears to involve all of the tissues 
of the organ. The eyelids are swollen, red and somewhat ede- 
matous. The edema extends over the whole malar region. 
Exophthalmus well marked. Pupil contracted and immovable. 
Conjunctiva in a state of catarrhal inflammation. Hypopion. 
Sent to the New York Hospital, August 30, for treatment by 
specialist of the eye complication. This is the only case of 
secondary infection of eye of a typhoid character that was ob- 
served in the camp. It was a well-marked case of panophtal- 
mitis and if the patient recovers it will be with the loss of the 
affected organ. 

ERYSIPELOID. 

Erysipeloid, an acute inflammatory affection of the skin, 
described by J. Rosenbach, is a disease of the skin not often 
recognized. It is usually mistaken for erysipelas. The para- 
site was described by Rosenbach more than ten years ago, but 
it has never been classified. Attempts to cultivate it have 
failed so far. This disease is met with usually among persons 
engaged in the handling of fish and meat, that is, cooks 
and butchers. It is attended by very slight constitutional 
disturbances and its local progression is slow as compared 
with erysipelas. The starting point is generally a finger, 
where infection takes place through slight surface defects or a 
puncture. It consists, pathologically speaking, of a subacute 
inflammation of the lymphatic channels of the skin. The 
affected skin presents a bluish color instead of the bright red 
seen in erysipelas. Another and perhaps more important 
characteristic sign in the differentiation between erysipeloid 
and erysipelas is the appearance of the margin of the inflamed 
area. In erysipeloid the shading from diseased into healthy 
skin is gradual, the line straight, in erysipelas abrupt and the 
margin presents well-marked fan- shaped projections instead of 
a straight line. The thickening of the skin by infiltration in 
erpsipeloid is slight and the only thing the patient complains 
of is a sensation of burning or smarting. The disease travels 



214 

in the direction and against the lymph-current, so that when 
the point of infection is some distance from the tip of the 
finger, this is reached in time by extension of the inflammation 
downward from the point of infection. The disease travels 
slowly, it usually takes a week or more before the inflamma- 
tion reaches the base of the finger when infection takes place 
anywhere near its tip. The lymphangitis seldom if ever 
extends beyond the elbow joint. The infection may extend 
from one fioger to another when the inflammation travels in a 
distal direction. The skin soon returns to its normal condi- 
tion behind the zone of infection. A case of this kind came to 
the surgical ward for treatment. 

Case 41. — Patrick J. M. McGeoch, age 24, kitchen employe, 
presented himself September 9, complaining of a burning, 
smarting pain in the right index finger, which commenced 
four days ago. Over the radial side of the affected finger, 
opposite the middle joint, is a small abrasion covered by a thin 
adherent crust. The skin half as far as the tip of the finger 
and an inch above this point is slightly swollen and presents a 
bluish-red color. The discoloration is most marked on the 
dorsal side. At the proximal margin of the zone of inflamma- 
tion the diseased gradually shades into the healthy skin, both 
in regard to color and swelling. Patient is able to follow his 
occupation. The case presents all the characteristic signs of 
Rosenbach's erysipeloid. An alcohol compress with oiled silk 
over it was applied. In three days the inflammation had 
extended to the base of the finger while the distal portion, the 
seat of the disease when the patient first came under observa- 
tion, presented a normal appearance, the skin being somewhat 
shrivelled by the action of the alcohol application. 

AFFECTIONS OF THE RECTUM, ANUS AND ADJACENT TISSUES. 

Rectal affections in some form were very common among the 
returning troops from Cuba. It is fair to presume that some 
of the soldiers were the subjects of a mild form of hemorrhoids 
when they entered the service, but it is equally certain that 
none of them were affected with fistula or abscess. To show 
the disproportion of rectal disease between the recruits who 
applied for enlistment and the soldiers returning from the 
field, I will state that of 10,000 applicants examined in Camp 
Tanner last spring the following rectal affections were noted : 
Hemorrhoids, internal, 2 ; external, 219 ; inflamed, 1 ; fistula, 
1 ; prolapsus, 2. I attribute the prevalence of rectal diseases 
among our patients in this camp to the following causes : 1, 



215 



intestinal affections contracted in the camps and Cuba ; 2, 
improper food ; 3, the relaxing effect of a tropical climate ; 4 
frequent exposure. Few of our soldiers escaped diarrhea or 
dysentery. The irritation of the rectal mucous membrane 
could not fail in many instances to produce a catarrhal proctitis. 
The inflamed mucous membrane became permeable to the 
passage of pathogenic microbes, which so constantly infest 
even the healthy rectum. The loose pararectal connective 
tissue, under the influence of general causes, became more sus- 
ceptible to infection, it is therefore not astonishing that we 
should have found so many cases of perianal, perirectal and 
ischiorectal abscesses and their consequences, fistulas. Inflam- 
matory affections of the rectum play also an important etio- 
logic role in the development of hemorrhoids. We found in a 
number of cases a direct connection between an antecedent 
rectal inflammatory affection and the subsequent appearance 
of hemorrhoids. The intense tenesmus which attends catarrhal 
proctitis and dysentery causes muscular changes and lesions of 
the mucous membrane which often become the principal cause 
of pararectal inflammation and hemorrhoids. 

PARARECTAL ABSCESS. 

Under this head I will report all cases of suppurative inflam- 
mation in the vicinity of the anus and outside of the rectal 
wall that have been operated on in Camp Wikoff. In all cases 
the suppurative inflammation pursued a very rapid course, 
The pain, as a rule, was intense, and fluctuation could be felt 
distinctly in the course of four or five days. In high-seated 
paraproctitis the general symptoms were usually severe, a high 
temperature and a rapid bounding pulse. It was in these 
cases that the affection assumed the most progressive form. 
The abscess contents were always fetid, otherwise presented 
the usual appearance of pus as found in acute abscesses in 
other localities. 

Case 42.— Robert F. Stanley, age 22, Troop G, Ninth Cav- 
alry, colored. Perianal and ischiorectal abscess. While in 
Cuba had diarrhea for eighteen days — August 27 to Septem- 
ber 1— had chills and fever. Reached Camp Wikoff Septem- 
ber 3, on which day he had pain about the rectum before and 
during defecation and on sitting down. He was admitted to 
surgical ward September 8. By careful palpation a small area 
of circumscribed induration as large as a pea could be felt on 



216 

the right side of the sphincter muscle and about one- third of 
an inch from the surface. This swelling could not be detected 
from the rectum. Pain was greatly increased under pressure. 
A small incision was made and about half a dram of pus 
escaped. The little cavity was washed out with peroxid of 
hydrogen and carbolized water and loosely packed with a strip 
of iodoform gauze. As an external dressing a hot moist anti- 
septic compress was used and held in place by a T bandage. 
Immediate and almost complete relief followed the operation. 
On the ninth, the temperature rose to 100 degrees F., on the 
tenth to 101. The pain was intense and referred to the oppo- 
site side of the rectum, September 10, a fluctuating swelling 
could be felt from the perineum and the rectum. The abscess 
bulged externally as well as on the rectal side. The patient 
was again anesthetized and the abscess incised through the 
perineum to the left of the median line. A large quantity of 
extremely fetid pus escaped. As the undermining was exten- 
sive two counter-openings were made, one below and one above 
the first opening. Two fenestrated rubber tubes were employed 
in draining the large cavity. The abscess was washed out with 
carbolized solution and peroxid of hydrogen, and the moist 
antiseptic compress applied. The pain was relieved at once 
and the discharge after the operation slight. No tendency to 
further undermining, on the other hand all indications point 
to an early and permanent healing of the abscess cavity. 

It is in cases like these that practitioners so frequently make 
a serious mistake by postponing from day to day opening and 
draining of the abscess. If we had deferred the operation for 
another day or two the abscess would have ruptured into the 
rectum and would have led almost inevitably to the formation 
of an internal or complete fistula. The horseshoe fistulae fol- 
lowing cases of ischio- rectal abscess, so frequently found in 
any of the large surgical clinics are the best proof of the neces- 
ity for early operative interference. The rule should be to 
open such abscesses early, from the external surface, and if 
fluctuation can not be felt from this direction but from the 
rectum, the tissues on the side of the rectum can be tunnelled 
with forceps after making a superficial incision, until the 
abscess cavity is reached. The surgeon must so conduct the 
treatment that the formation of a fistula can be avoided, and 
this can be done in nearly all, if not all, cases in which the 
abscess is opened before it ruptures into the rectum. 

Case 45.— Alva J. Vananken, age 27, Troop K, First Cavalry. 
Perirectal abscess. On his last day in Cuba the patient had a 
mild fever and diarrhea ; the latter persisted fifteen or sixteen 
days. For the last ten days has had a throbbing pain in the 



217 

post anal region. An abscess found and opened in the median 
line, between the anus and coccyx. Under ether anesthesia the 
abscess cavity behind the rectum was freely opened with the 
Paquelin cautery, taking the fistulous opening in the median 
line as a guide for the incision. The cavity was thoroughly dis- 
infected and packed with iodoform gauze, over which the usual 
moist dressing was applied. Rapid healing of the cavity by 
granulation. 

Case 44. — Robert Sylvester, age 24, Company G, Fourth 
Artillery. Has been ill with typhoid malarial fever while in 
Cuba. Returned from Cuba on the steamer Leova, and 
reached Camp Wikoff about September 1. Soon after his 
arrival he noticed pain on the left side of the rectum. The 
pain and tenderness increased rapidly in intensity. September 
7, he was admitted to the surgical ward and the operation was 
performed without anesthesia three days later. At this time 
the abscess was prominent on the side of the anus and the over- 
lying skin presented an inflammatory blush. Fluctuation 
very distinct from the rectum as well as from the surface. The 
abscess was opened by a single incision and tubular drainage 
established, as the incision was large enough to serve for 
drainage. After disinfection of the cavity and packing it 
lightly with iodoform gauze, a moist antiseptic compress was 
applied. The patient was very weak at the time the operation 
was performed, but gained sufficiently in strength in a week to 
warrant his transfer to a hospital in Philadelphia. 

Case 45. — Joseph Barret, age 28, Third Infantry, Company 
G. Ischio-rectal abscess. About the time of the surrender of 
Santiago had general malaise, fever, vomiting and diarrhea for 
which he has since been on the sick list. Several days ago he 
began to experience pain in the rectum which has increased 
steadily since, and at the time he was admitted to the surgical 
ward the ischiorectal abscess had opened spontaneously on the 
right side just within the anal margin. General health much 
improved. On August 31, under chloroform anesthesia the ab- 
scess cavity was distended with peroxid of hydrogen for the 
purpose of ascertaining its exact size and location. A grooved 
director was inserted into the fistulous opening and used as a 
guide in laying open the abscess cavity freely with the knife 
point of the Paquelin cautery. The abscess cavity was disin 
fected and packed loosely with iodoform gauze over which the 
moist compress was applied. He improved rapidly after the 
operation and a few days later was transferred to a hospital in 
Boston. 

Case 46. — William Head, age 20, Eighth Ohio Infantry, 
Company G, enlisted two and a half months ago. Admitted to 
the surgical ward with a history of malarial fever and dysen- 
tery in Cuba, followed by ischiorectal abscess which discharged 
itself near the anal orifice on the right side. Discharge con- 
tinues profuse. The peroxid of hydrogen test was applied to 



218 

ascertain the extent of the abscess cavity which was found to 
extend high up into the ischiorectal fossa. Owing to the 
marked anemia and general debility a counter-opening was 
made lower down and thorough drainage secured, in place of 
opening the abscess cavity freely with the Paquelin cautery. 
Chloroform was used as an anesthetic. The general and local 
conditions improved promptly after the operation. 

FISTULA. 

The spontaneous rupture of a pararectal or ischiorectal ab- 
scess into the rectum is generally followed by the formation of 
a fistula. If the abscess communicates with the rectum its 
existence can be surmised from the intermittent discharge of 
pus and local symptoms which refer to the rectal lesion. An 
internal fistula of such an origin is often made complete by the 
abscess finding eventually an external outlet somewhere in the 
anal region. An external fistula caused by the opening of a 
pararectal abscess not infrequently becomes complete by 
the destructive process penetrating the rectal wall. I have 
long ago abandoned the probe in differentiating between an ex- 
ternal fistula and a complete one. Injection of peroxid of hy- 
drogen into the cavity under pressure makes a positive diagno- 
sis at once. If the fistula is external the abscess cavity be- 
comes tense, if complete the peroxid foam enters the rectum and 
will escape from the anus. The probe is only used after the 
test has made the diagnosis and then only as an aid in perform- 
ing the necessary operation. In diagnosticating the existence 
and location of an internal fistula the rectal speculum is of 
the greatest importance. Rectal fistula will be less frequently 
met with when the profession as a whole recognizes the import- 
ance of early operative interference in cases of pararectal abscess. 
In my surgical work in Camp Wykoff only two cases of rectal 
fistula presented themselves for operative treatment. 

Case 47. — Lieut. G. W. Goode, Troop I, Ninth Cavalry. 
Hemorrhoids and fistula. He was admitted to the surgical 
ward August 24. He has been almost habitually constipated, 
and has been much in the saddle. He knows of no definite pre- 
ceding illness to account for present condition. He has had 
much pain and bleeding on defecation, pain persisting for 
an hour or two after. Examination reveals large internal 
and external hemorrhoids and an incomplete internal fis- 
tula following the rupture of a post rectal abscess, into the 
rectum through the middle of the sphincter muscle, posterior 
side. The abscess cavity, the size of a walnut, was freely laid 



219 



open upon a grooved director with the knife point of the Pa- 
quelin cautery. The incision was carried directly backward 
through the median line. The hemorrhoids, two in number, 
affecting the posterior segment of the anal ring were removed 
by clamp and cautery. The abscess cavity was loosely packed 
with a strip of iodoform gauze. The rectal tampon re- 
mained for two days, The patient made a rapid recovery and 
was able to leave the hospital September 13. The agonizing 
pain attending and following each bowel movement disap- 
peared immediately after the operation. 

Case 48.— John M. Boyd, age 29, Troop G, Third Cavalry, 
enlisted four months ago. Admitted to the surgical de- 
partment of the General Hospital August 27. His health was 
good until he went to Tampa, June 8. At that time he suffered 
from diarrhea which was persistent, but did not prevent his 
doing duty in the saddle. For the past five weeks and following 
a severe pain in the rectum which continued several days, he 
has noticed a discharge of pus from the rectum. The pain did 
not disappear entirely after the abscess ruptured into the rectum 
and was always aggravated during defecation. August 28, 
under chloroform anesthesia the sphincter ani was dilated, the 
internal opening was found, the cavity distended with peroxid 
of hydrogen, external counter-opening made by the aid of the 
grooved director and the intervening tissues divided with the 
Paqueiin cautery. Iodoform gauze packing and dry dressing. 
The internal openiog in this case was just above the sphincter 
muscle, the abscess on the right side of the rectum. Rapid 
healing of the abscess cavity. 

HEMORRHOIDS. 

A large number of hemorrhoid cases came to the surgical 
ward with the desire and expectation of receiving the benefits 
of a radical operation. I am satisfied that only a small per- 
centage of those affected were willing or prepared to be sub- 
jected to an operation. Some of the cases examined perempto- 
rily declined to receive treatment knowing well that the re- 
sults would put one claim for pension beyond their reach. In 
my capacity as operating surgeon of the camp I was very anx- 
ious to curtail the list of pensioners of this war by performing 
operations for surgical affections which, if left alone, would 
furnish a just claim upon the Government. On the whole, I 
found the colored soldiers much more willing than their white 
comrades to be benefited by surgery. They proved themselves 
worthy of their hire in the hospital as well as on the battle- 
field. Too much can not be said in praise of our colored sol- 
diers. They showed a staunch faith in their doctors as well 



220 



as their commanders, and were ready at all times to follow 
their advice as well as the commands of their officers. Nearly 
all of the hemorrhoids operated on showed pathologic ap- 
pearances which demonstrated their recent origin. In a very 
large percentage of cases the first manifestation of hemor- 
rhoidal condition was preceded by intestinal disturbances, 
diarrhea or dysentery. Fortunately, I had two Paquelin cau- 
teries at my disposal as soon as the operating tent was opened. 
As I said in the beginning of this paper, my instrumentarium 
at first was a very scanty one. Instruments, however, began 
to come, day after day, and finally I had an excellent supply, 
including a number of cases for special work. The absence 
of a proper pile clamp from the outfit of the surgical ward at 
the outset, necessitated the use of something as a substitute. 
This was found in a curved hemostatic forceps. Except for its 
lightness, and therefore comparatively inefficient grasping 
power, this answered the purpose admirably. In fact, the 
facility and accuracy with which the hemorrhoidal swelling 
could be clamped and isolated, the small space required for 
its use, and its general convenience and ease of handling as 
compared with heavy clamps, now in the market, led to the 
devising by Major Adams of Chicago, of a hemorrhoid clamp 
similar to the forceps used, but so constructed as to obviate 
the defects of weakness and imperfect grasp found in that in- 
strument. The use of the forceps as a clamp has demon- 
strated that the amount of pressure and crushing exerted by 
the old-fashioned instruments are unnecessary and uncalled 
for ; also that there is no need of ivory plates to prevent the 
transmission of heat through the metal of the forceps to the 
underlying mucous membrane, as in no instance was any ill 
effect observed from this cause. x\nother advantage of the 
narrow blade forceps has been demonstrated in the absence of 
any hemorrhage whatever after operation. The new clamp 
has blades with a serrated grasping surface 5 cm. long, curved 
on the flat, the width of the blades closed is 9 mm., their 
thickness 6 mm., beveled away from the upper to the outer 
edge for 1 mm. The object of the bev^el is to allow of the oper- 
ation of the cautery with the least possible contact with the 
metal of the clamp, to avoid heating. The blades come into 
contact at the point first, so that uniform prossure is exerted 



221 



the whole length of the blades when closed, and the hemor- 
rhoid can not escape its grasp at the point, as often happens 
with the ordinary clamp. 

The handles are arranged like those of a needle forceps. 
With one exception the hemorrhoids were removed with the 
knife point of the Paquelin at a dull red heat, after clamping 
the swelling at its base. The hemorrhoid was first grasped 
with a dissecting or hemostatic forceps, when the base of the 
cone elevated to the desired extent was grasped and clamped 
with the forceps and the mass outside of the grasp of the in- 
strument shaved away with the cautery. The operation of 



LATERAl-Yf^VV 




t/pPBR Surface. 




Tf^AN'SVEKSe SeCTJO/V OF* BlADES • 

Hemorrhoid clamp, devised by Major Adams. 

removal was always preceded by dilatation of the sphincter. 
The patients were always properly prepared for the operation 
the day before. The rectum was thoroughly cleared out by 
the administration of a cathartic and irrigation. The last 
enema was given on the morning of the operation. Asa rule, 
two or three seizures were made. After dilatation of the 
sphincter the hemorrhoidal swellings were located and grasped 
with forceps so that the work of clamping and cauterization 
could proceed without interruption. Care was exercised in 
every case not to remove too much tissue ; due allowance was 
given for subsequent contraction. The anal region was 



222 



shaved and prepared in the same manner as for operations in 
other localities. One of the principal sources of pain after 
operations for hemorrhoids has been the^ protrusion and swell- 
ing of the cauterized surfaces. For many years I have suc- 
ceeded in preventing this very painful post-operative complica- 
tion by resorting to drainage aud rectal tamponade. This 
method of dressing rectal wounds after this operation is not 
sufficiently known and practiced. Those who have not tried it 
might entertain a fear that it is a source of distress rather 
than comfort. Quite an extensive experience with this 
method of after-treatment enables me to make the unqualified 
statement that the rectal tampon, properly applied, is well 
borne by the patients and makes the use of anodynes superflu- 
ous. I never administer opiates after operation for hemor- 
rhoids. The rectal tampon not only obviates unnecessary pain, 
but it also is almost an absolute protection against secondary 
hemorrhage and more than this, it provides for free rectal 
drainage and constitutes the best possible dressing for the 
cauterized surfaces. 

When I first used this tampon, I was under the impression 
that it was something new, but I learned later that Mitchell 
Banks had used a very similar contrivance before. The tam- 
pon is made by taking a piece of rubber tubing eight inches in 
length and inserting into it a glass cylinder three-fourths of an 
inch in diameter and about 2 inches in length. The glass tube 
is placed where the gauze tent is tied over the rubber tubing 
for the purpose of furnishing a support to the string with w^hich 
the gauze tent is tied upon the tube and to insure patency of 
the tubular drain. The rubber tube should project well over 
the glass cylinder on the rectal side. The gauze tent is made 
of one or two layers of iodoform gauze. After completion of 
the operation the tent is carefully folded and the upper portion 
covered with vaseline. The tube is then inserted into the rec- 
tum to the depth of three or four inches and the space between 
the tent and tube packed with strips of iodoform or plain sterile 
gauze. After the required amount of packing is inserted the tam- 
pon is pushed in the direction of the rectum sufficiently to bring 
the pressure above ,the grasp of the sphincter muscle. In doing 
this the projecting mucous membrane and what may remain of 
the external hemorrhoids are completely reduced. The gauze 



223 




Rectal tampon. Rubber tube 20 cm., glass tube 8 cm. 



224 



outside of the anal orifice is then wound around the tube and 
forms a part of the external dressing. Over the gauze a wide 
ring of absorbent cotton is applied and the whole retained in 
place by a T bandage. The tampon should remain for 24 to 48 
hours. 

In removing it traction is made on the gauze tent sufficiently 
to bring the packing within easy reach when it is removed be- 
fore an attempt is made to extract the tube. After the removal 
of the tampon the patient should be given a laxative and after 
this has acted the cauterized surfaces now minus the eschar 
are protected by applying carbolated vaseline or some other 
antiseptic non irritating ointment. I have made it a rule to 
keep the patient confined to bed for at least a week, still better 
two weeks. The cases of hemorrhoids operated upon in this 
camp with very few exceptions have been men whose general 
health was much impaired, yet in every case the wounds healed 
quickly and in the most satisfactory manner under the treat- 
ment outlined above. 

Case 49.— M. J. McNulty, age 31, Company D, Sixteenth 
Infantry, enlisted six months ago. Has had small hemorrhoids 
for two years, causing inconvenience only after heavy drinking. 
In June, while in Florida, bleeding at stool occurred for the 
first time. Since he suffered from malarial fever and diarrhea 
during the Cuban campaign, he has suffered from profuse 
bleeding on defecation. September 3, under chloroform anes- 
thesia, three hemorrhoidal swellings were removed. 

Case 50. — George Morton, age 47, sergeant Ninth Cavalry, 
Troop A, colored, has been in the service ten years and seven 
months. Had dysentery two months ago, since then has suf- 
fered from pain in the rectum and bleeding with each evacua- 
tion of the bowels. August 26, under chloroform anesthesia, 
three hemorrhoids, partly external and partly internal, were 
removed by clamp and cautery. 

Case 51. — Jesse Donaldson, age 30, Troop M, Ninth Cavalry, 
colored, enlisted three months ago. While in Tampa, patient 
suffered from malarial fever and diarrhea, the latter continued 
for three or four days. Has not been well since that time. 
Since August 1, he has been much inconvenienced by a hemor- 
rhoidal affection which developed recently. Operation per- 
formed under chloroform narcosis, September 2. Three inter- 
nal hemorrhoids, two posteriorly, one at upper right quadrant, 
were removed in the usual way by clamp and cautery. 

Case 5^.— Claude F. Hall, age 23, Company G, Sixteenth 
Infantry, had hemorrhoids about four years ago, but not so 
severe an attack as the present. Recovered without operation. 



225 



Has been in the service since the 17th of September, a year 
ago. Following an attack of malaria and diarrhea in Cuba, he 
has been suffering from hemorrhoids for the past six weeks. 
He has no bleeding, but the hemorrhoids have been protruding 
constantly and are very painful. September 7, under chloro- 
form anesthesia, three internal hemorrhoids were removed in 
the usual manner by clamp and cautery. They were located 
respectively in the posterior right and left quadrant. 

Case 52, — James Jervis, age 19, Company K, Thirty fourth 
Michigan Infantry, enlisted three and a half months ago. Had 
diarrhea two weeks, before leaving Cuba. Has had much pain 
and bleeding with movements of bowels since. Never had rec- 
tal trouble of any kind before. August 31, under ether anes- 
thesia, two internal hemorrhoids were removed. 

Case 55.— Ora Keithley, age 23, Troop M, First Vol. Cavalry, 
first suffered severe pain from hemorrhoids in July, when on 
duty in Cuba. He had had previously an attack of rheuma- 
tism from exposure to rough and wet weather and sleeping on 
wet ground. On September 7, three hemorrhoids, partly ex- 
ternal and partly internal, were removed. 

Case 54. — Horace Carden, age 24, Troop M, First Vol. Cav- 
alry, has suffered off and on for three years from hemorrhoids, 
the present attack was not preceded by any bowel complaint or 
other illness. Has had no bleeding, but much pain and itch- 
ing. Operation under chloroform anesthesia, September 8, 
when three internal hemorrhoids were removed. 

Case 55. — Silas McGovern, age 28, Troop A, Ninth Cavalry, 
colored, has been in the service three years. Patient was ad- 
mitted to the surgical ward September 8. One week ago, 
directly following an attack of diarrhea, he noticed pain in the 
rectum on defecation. The mucous membrane of the rectum 
protruded with each stool. Day after admission the patient 
was chloroformed and three internal hemorrhoids were re- 
moved. The appearance of the swellings indicated their recent 
origin. The mucous membrane was in a state of catarrhal 
inflammation. The posterior half of the anal ring was princi- 
pally affected by the hemorrhoids as well as by the catarrhal 
inflammation. 

Case 56.— Joseph Etter, aged 19, Troop I, Ninth Cavalry, 
colored, has suffered for the past two months from hemorrhoids 
which he believes were brought on by heavy lifting. Since the 
supposed "strain" he has experienced severe burning pain 
with each movement of bowels and profuse bleeding. Pain has 
been persistent after stools for several hours. September 8, 
under chloroform, three large, dark-blue hemorrhoids were 
found, one on right and left side posteriorly, and one on ante- 
rior left quadrant. The swellings were removed as usual by 
the use of clamp and Paquelin cautery. 

Case 57. — Lee Shanks, age 26, Troop A, First Vol. Cavalry, 
has been in the service three months. He has been suffering 



226 

from hemorrhoids for the past month with no illness preceding. 
He has had much pain after defecation, but no bleeding. 
Under chloroform three external hemorrhoids were removed, 
September 2. One of the swellings occupied the posterior wall 
of the rectum to the right of the median line, one to the left 
of the median line posteriorly, and the third in the anterior 
left quadrant. The hemorrhoids were disposed of in the usual 
manner. 

Case 58. — Corporal Samuel H. Edwards, Troop C, First Cav- 
alry, began to suffer from profuse bleeding on defecation the 
latter part of July, following an attack of diarrhea while on 
duty in Cuba. Pain has not been severe at any time. Sep- 
tember 10, under chloroform anesthesia, four very large inter- 
nal hemorrhoids were removed by clamp and cautery, two 
from either side of the median line anteriorly. The hemor- 
rhoids in this case were distinctly venous, the swellings being 
composed of ectatic veins almost exclusively. 

Case 59. — Henri Meuronval, age 43, Company F, Second 
Volunteer Engineers, has suffered from hemorrhoids since 
puberty, with exacerbations at varying intervals. Recently 
much pain and bleeding. Examination under chloroform, 
September 11, revealed a large internal venous hemorrhoid on 
the right side, which, owing to the fact that the Paquelin 
cautery did not work that day, was treated by ligature. Before 
the silk ligature was applied, the mucous membrane at the 
base of the swelling was incised. An ulcer as large as a dime 
was detected directly over the sphincter muscle in the median 
line and posterior surface. This ulcer was evidently the remote 
result of a retroanal abscess which occurred a year ago, Since 
that time the pain during and after defecation has been much 
more severe. Besides stretching the sphincter, preliminary to 
ligation of the hemorrhoid the superficial fibers of the sphinc- 
ter muscle were divided, carrying the incision through the 
center of the anal ulcer. Rectal tamponade as usual. The 
pain was relieved promptly by the operation. 

Case ^^.— Capt. Nat Phister, age 44, Company G, First 
Infantry, has had attacks of hemorrhoidal distress in 1888 and 
1893 but not so severe as at the present time. He has suffered 
severely with present attack since August 19, the exciting 
cause being constipation. The suffering was much aggravated 
by a long ride in the saddle which he was compelled to take 
while the hemorrhoids were prolapsed. Since that time has 
had severe pain and constant muco sanguinolent discharge, 
necessitating the wearing of a diaper. Under chloroform a 
medical operation was performed September 8, consisting in 
the removal of two large hemorrhoids, largely external, and 
affected by extensive excoriations. The operation afforded the 
desired prompt relief. 

Case 61.- -John M. Dixon, age 40, Company B, First Infan- 
try, had an operation seven years ago and had no trouble after 



227 

that until about the first of August, when after a prolonged 
attack of dysentery he began to suffer with prolapse of the 
rectum. He has been in the service seventeen years and when 
last attack occurred he was in Cuba. He reached Camp 
Wikoff September 13. He has been greatly debilitated by the 
dysentery, and the prolapse occurs whenever he assumes the 
erect position or attempts to walk. Has much constant dis- 
tress with pain, smarting, itching and occasionally bleeding. 
Under anesthesia operation was performed September 14. A 
large hemorrhoid was removed from the posterior aspect of the 
rectal wall and a vertical strip of mucous membrane by clamp 
and cautery. A smaller swelling and strip of mucous mem- 
brane were removed from the left quadrant in a similar man- 
ner. Rectal tamponade. Strict directions were given that the 
patient should be kept in the recumbent position for at least a 
week. 

Case 62. — James Skinner, age 28, Troop H, Ninth Cavalry, 
colored, was sick in Cuba with dengue fever, about twenty 
days, beginning about July 14. Recovered only partially from 
this before (beginning August 14) he had an attack of malarial 
fever lasting fifteen days. During both attacks he had poig- 
nant diarrhea. During the early stage of malaria the hemor- 
rhoids appeared, with much pain, prolapses and bleeding. On 
September 13, under ether narcosis, two internal hemorrhoids 
were removed from the posterior wall of the rectum middle 
line, and the right posterior quadrant. Patient's health much 
impaired, anemia marked. 

Case 63. — John Holloman, age 22, Troop B, Ninth Cavalry, 
colored, has always been in good health until the latter part of 
July, when he had diarrhea for three days while on duty in 
Georgia. Since then he has had pain on defecation, prolapse 
of the bowel and sensation of incomplete evacuation, but no 
bleeding. September 15, the patient was etherized and four 
internal hemorrhoidal masses removed by clamp and cautery. 

Case 64. — Abraham Hill, Company C, Twenty-fourth Infan- 
try, colored, has been in the service twelve years. About eight 
years ago he had hemorrhoids, which were operated on success- 
fully. For the past three months, while on duty in Cuba, he 
has been suffering great pain on defecation and slight bleeding. 
Rectal prolapse at stool, always easily reduced. Has enjoyed 
fair health and attributes the attack to the heat and dampness 
of the Cuban climate. Operation under chloroform anesthesia 
performed September 16. Three very large internal hemor- 
hoids, located posteriorly and laterally, were removed in the 
usual way by the clamp and cautery. 

The cases related above are instructive in showing what kind 
of surgery may be expected among soldiers who have partici- 
pated in a campaign in a tropical country, subject to its indi- 
genous diseases and debilitated by its climate, improper food 



228 



and exposures. The results obtained must also counsel the 
military surgeons to practice their art not only on the battle- 
field, but also for surgical lesions caused independently of 
wounds and so often overlooked in the field hospitals. I have 
to record only two deaths, and both patients were operated on 
in the wards of the general hospital, being too weak to be 
transferred to the surgical ward. Both of them were low with 
typhoid fever complicated by large metastatic abscess, in one 
the parotid, in the other the submaxillary being involved. 
One died the next day after incision and drainage, the other 
on the third day. 1 am satisfied that many of our cases of 
phlegmonous and typhoid abscesses would have died without 
timely and thorough surgical interference. In many of the 
other cases, more especially hemorrhoids and fistula, the oper- 
ations performed will restore the men, with the aid of proper 
general treatment, to their usual condition, and cut them off 
from the pension list. In all aseptic cases the wounds healed 
by primary intention, the best possible proof that good surgi- 
cal work can be done in an operating- tent in the field, and with 
very limited facilities for carrying out aseptic precautions. 
Since writing the above paper, a number of interesting surgi- 
cal cases have been operated on in the surgical ward, which I 
will now report under the head of 

MISCELLANEOUS CASES. 

Case (55.— Edward J. Hill, aged 23, Troop I, Ninth Cavalry, 
colored, enlisted three months ago. Painful tetanoid spasm 
following gunshot wound of heel. About two months ago, 
while in Tampa, accidentally shot himself through the left 
heel with a Krag-Jorgensen carbine (30 cal.). The bullet passed 
transversely in an oblique direction through the os calcis. 
There is no evidence of comminution of the bone, the contour 
being well preserved and the surfaces smooth. While under 
treatment for the wound, he thinks he contracted "rheuma- 
tism in both loins." He has suffered twice from painful teta- 
noid spasm of the gastrocnemius, the attacks lasting about 
three hours, then subsiding as suddenly as they came on and 
leaving the leg painless and useful. He entered the hospital 
August 28, suffering from a third attack which lasted more 
than twenty-four hours, subsiding suddenly during the night 
after his admission. The gastrocnemius is firmly contracted, 
the heel raised, and any attempt to extend the foot aggravated 
the pain. No tenderness of heel or scars. 

Case 66,— Wade H. Bell, age 21, Company A, Sixteenth In- 



229 

fantry, enlisted May 23. He has been troubled with varicocele 
for the past two months. It causes soreness and pain on walk- 
ing any distance, incapacitating him for guard duty, and he 
believes the difficulty is gradually increasing. He first noticed 
the varicocele when he was sick first with malarial fever for 
five days. Had three such attacks. Veins nearly the entire 
length of the cord much dilated and tender on pressure. Oper- 
ation by excision under chloroform anesthesia, September 5. 
Transverse suturing of the external wound to shorten the elon- 
gated scrotum. 

Case 67.— James H. Hebel, age 21, Battery 3, Fourth Artil- 
lery, enlisted three and a half months ago. Purulent ophthal- 
mia and perforative keratitis. On Saturday, August 27, he felt 
sensation of a foreign body in the right eye. The next day 
profuse purulent discharge. On examination August 31, the 
conjunctiva was found intensely swollen and vascular, dis- 
charge of pus profuse, eyelids swollen and edematous, pupil 
contracted ; beginning of ulceration near the center of the 
cornea ; beginning pannus, intense photophobia. There is no 
trace of gonorrheal infection. The treatment consisted of fre- 
quent cleansing with boracic acid solution and application of 
ice. Atropin could not be secured for three days. After that 
time it was used in sufficient strength to dilate the contracted 
pupil. In spite of all that could be done, the corneal ulcer 
perforated and the anterior chamber of the eye was partially 
evacuated. At this time the patient obtained a furlough and, 
on his own responsibility, undertook the journey to his home 
in Chicago. He was advised to place himself on his arrival 
under the care of Professor Hotz. 

Case 68. — George Slate, age 24, civilian. Habitual disloca- 
tion of the left shoulder joint. This is the sixth time during 
the last two years the accident occurred. Patient probably 
under the influence of liquor when injured, as he does not 
know how it happened. Became aware of the dislocation on 
waking up in the morning. Several contusions on other parts 
of the body were discovered. Dislocation of head of humerus 
downward and forward underneath coracoid process of the 
scapula. On request of the patient chloroform was adminis- 
tered, and the luxation reduced very easily by extension and 
rotation. The arm was immobilized by a Velpeau bandage. 
Accident September 15, reduction the following forenoon. 

Case 69. — Peter Hansen, age 32, farrier, Troop L, First Cav- 
alry, fell from stumbling horse September 15, in such a way 
that he struck the ground with his left shoulder. He has 
been unable to raise his arm since. Carries affected shoulder 
lower than the opposite one. Pain and circumscribed tender- 
ness over the clavicle about an inch from the acromio-clavic- 
ular articulation. Patient somewhat obese, so that the distal 
side of the clavicle can not be readily traced. Fracture of the 
clavicle near the accromion process was diagnosticated, al- 



230 

though no distinct displacement could be made out or crepi- 
tus elicited. Arm supported in a mitella. 

Case 7().— Edward Consan, age 24, Troop I, Ninth Cavalry » 
colored. Enlisted four months ago. Admitted to the surgical 
ward September 7, with swelling and extreme tenderness of 
anterior surface of the left tibia. Previous diagnosis of osteo- 
myelitis had been made. No history of injury. The swelling 
is most marked over the central portion of the shaft of the 
bone. The onset of the disease, the location and character of 
the swelling and the nocturnal exacerbations of the pain left 
no doubt as to the syphilitic nature of the periostitis. Inquiry 
develops a history of primary syphilis four years ago. Has had 
secondary eruptions and mucous plaques, etc., and at the 
present time there is hyperplasia of the lymphatic glands in 
all the principal accessible regions. 

Rest in bed, elevation of limb, hot, moist, antiseptic com- 
press and the internal use of potassic iodid in 15 grain doses, 
four times a day constituted the treatment that was directed. 
Under the iodid the pain and tenderness diminished, as well 
as the swelling. A few days after his admission a small 
fluctuating swelling could be felt in the center of the inflamed 
area, but as no pus was expected the use of the knife was 
refrained from. This superficial central softening is often seen 
in gummatous swellings and will disappear under the treatment 
the patient is receiving now. If absorption of the liquid con- 
tents of the fluctuating swelling does not take place, tapping 
and washing out with a 5 per cent, solution of carbolic acid 
will be resorted to. 

Case 71. — L. J. Torney, age 24, Troop D, Sixth Cavalry, has 
been in the service two years and four months. Pressure paral- 
ysis of radial nerve. While in Cuba was in the hospital three 
days for chills and fever. He joined his command after his 
discharge from the hospital and was quite well for three weeks, 
when suddenly he became unconscious and was afterward 
wildly delirious and had to be tied to a litter for saffe trans- 
portation. During: this trip he lost the use of the extensor 
muscles of the right hand. The paralysis remains complete, 
otherwise the patient is in fair condition, although occasion- 
ally the temperature rises to 102 P. The patient is not con- 
fined to bed. The paralysis of the musculo spinal nerve was 
undoubtedly caused by pressure during the transportation on 
the litter. Massage and electricity were advised. 

Case 12. — Thomas Clemens, age 21, recruit. Twenty fourth 
Infantry, enlisted two months ago. Hydrocele of the cord. 
Came to the surgical ward for diagnosis September 16. Six 
months ago, while in the act of lifting a heavy box, was taken 
rather suddenly with pain in the right side of the scrotum. 
In a few days a swelling developed, the size of a hazelnut, which 
has remained. The swelling is tender to the touch and is con- 
nected with the cord about an inch above the epididymis. The 



231 



sweliing is circumscribed and fluctuates distinctly. It was 
diagnosticated as a hydrocele of the cord. 

APPENDICITIS. 

It is somewhat astonishing that, in these days of appendi- 
citis rage, of the many thousand soldiers who have landed at 
Montauk, not one case of appendicitis came under my notice 
that would have justified an operation. We would naturally 
expect that among such a large body of men, almost all of 
them at some time during the last five months the victim of 
intestinal affections, the appendix should have claimed its 
good share of disease. The climate, the diet, the previous 
intestinal affections contracted in Cuba, should have, accord- 
ing to our ideas of the nature of appendicitis, combined in 
exciting the disease. But such was not the case. The profes- 
sion is well aware of the fact that surgeons who can see noth- 
ing else but appendicitis in cases in which the patients com- 
plain of pain in the right iliac fossa, have performed laparot- 
omy, and these cases were not few in number, where as an 
excuse for their error in diagnosis, they have completed the 
operation by removing a normal appendix. Of the three cases 
of supposed appendicitis sent to the surgical ward, in only one 
the diagnosis proved correct, and this case was such a mild one 
that an operation was not deemed justifiable. One proved to 
be malaria, and the third typhoid fever. 

Case 73. — Charles W. Dyer, age 19, Company K, Seventh 
Infantry, has been in the service only six weeks. He was taken 
sick September 11, and was transferred to the surgical ward 
three days later. The attack commenced with a chill and 
some fever, the following day pain in the right iliac region set 
in. Bowels constipated, no vomiting, loss of appetite. Had a 
similar attack a year ago, from which he recovered in a few 
days. On his admission to the surgical ward there was slight 
tenderness over the appendix and cecum, no tympanites and 
no palpable swelling or muscular rigidity, temperature only a 
degree above normal. Catarrhal appendicitis was diagnosti- 
cated, complicated probably by a similar condition of the 
cecum. Rest in bed, liquid diet and ounce doses of equal 
parts of castor oil and sweet oil, four hours apart, until the 
bowels move, constituted the treatment, under which the 
patient recovered in a few days. 

Case 74. — James Reid, age 21, Company I, Seventh Infantry, 
has been in the service three months. Was admitted to the 
surgical ward September 1, with the diagnosis of appendicitis. 



232 

The clinical history, as well as his cocdition at the time of 
admission, warranted a change in the diagnosis from appendi- 
citis to typhoid fever. The temperature was erratic, showing 
malarial complication, but the curve from day to day showed 
the typhoid part to our satisfaction. The tongue was brown 
and dry with red tip and margins. Pulse 100 and temperature 
at that time varied from 101 to 105 F. Abdomen tympanitic 
and great tenderness in the right iliac fossa. Numerous rose 
spots appeared on the abdomen next day. Under appropriate 
treatment the fever subsided gradually at the end of the ihird 
week of his illness. The great tenderness in the right iliac 
fossa undoubtedly led originally to a wrong diagnosis, but it 
simply indicated in this case deep typhoid ulcers in the lower 
portion of the ileum. 

Case 75.— Martin G. Norman, age 27, Seventh Infantry, 
Company C, enlisted three months ago. On leaving Santiago 
he began to feel bad with headache, anorexia and malaria ; 
became worse ; lost sleep and complained of pain in the stom- 
ach ; most severe on left side nnder costal arch ; bowels con- 
stipated, tongue large, flabby, with indented margin. Spleen 
markedly enlarged. At times has had pain in cecal region 
which disappeared promptly after the administration of a laxa- 
tive. Under quinin this patient improved rapidly. 

STRICTURE OF THE URETHRA. 

Case 76. — H. J. Ewing, age 54, Company A, Ninth Infantry, 
has been in the service twenty-eight years. Admitted to the 
surgical hospital September 12, and transferred the next day 
to a hospital in New York. Has suffered from stricture of the 
urethra for a number of years. Exploration with the olive 
pointed bougie reveals a small and tight stricture in the mem- 
branous portion of the urethra. The cause of the stricture is 
a fall upon the perineum he sustained in 1864. Denies ve- 
nereal infection of any kind. Of late years he has had at- 
tacks of stoppage of the urine. The stream is small and mic- 
turition frequent. Patient transferred to New York for treat- 
ment. 

Case 77. — Frank Hugh Banks, age 20, Ninth Cavalry, Troop 
D, enlisted three months ago. Has had several attacks of 
gonorrhea, the last, two months ago. The stricture for which 
he was admitted to the surgical ward September 1 involved 
the membranous portion of the urethra, was an old one and 
was much improved before he was transferred on the 8th to 
his command. By careful and prolonged attempts a No. 8 
bougie passed the stricture. The treatment consisted of grad- 
ual dilatation. 

Case 7<S.— T, C. Mark, age 29, Thirteenth Signal Corps, en- 
listed three months ago. Has stricture of the urethra dating 
back to gonorrhea two or more years ago. Examination made 
September 14 shows stricture half an inch back of the meatus 



233 

A 14 ; another just in front of the scrotum admitting A 12. 
Gradual dilatation was commenced, but patient was trans- 
ferred to a hospital in Boston two days later for further treat- 
ment. 

The few cases of gonorrhea, syphilis and stricture observed 
in Camp Wikoff speak well for the morality of our army. 

ADDITIONAL CASES OF FRACTURE. 

Two cases of fracture of the long bones occurring in men 
belonging to the Cuban Army are of interest in showing im- 
paired nutrition as one of the causes of delayed or non-union. 

Case 79. — Hillyard H. Felder, age 44, packer, not enlisted. 
Five weeks ago, in Cuba, fell from a freight wagon ; jumped 
to save himself and landed on his feet in a small hole, twisting 
his legs. He sustained a transverse fracture of the right tibia 
about an inch above the base of the inner malleolus, and a 
transverse fracture through the middle of the external malle- 
olus. He came to the surgical ward September 14, the left 
limb in lateral splints, the right in plaster of Paris bandage. 
None of the fractures of the right leg have united, and there 
are no signs of formation of provisional callus. Fracture of 
left fibula united with some deformity. Patient is over six 
feet in height and very much emaciated. Plaster of Paris 
bandage renewed on right limb ; no dressing for the left one. 
Operation for non-union of fracture of tibia advised as soon 
as the patient's general condition is improved. 

Case 80. — John Coleman, age 28, Irish, stevedore, employed 
at the dock, Montauk harbor. Admitted during the afternoon 
September 12, to the surgical ward. While handling lumber 
was struck on right side of face by a crowbar handle set in mo- 
tion by the slipping of a wrench. The accident occurred an 
hour before his admission to the hospital. The patient was 
unconscious and very restless. Right side of face swollen. 
Two small wounds had been sutured before he entered the hos- 
pital. Exophthalmos of right eye caused by retro-bulbar hem- 
orrhage, divergent strabismus and dilatation of pupil, which 
does not respond to light. Free hemorrhage from mouth ; no 
hemorrhage or serum discharge from either ear. Through the 
swollen part of the cheek the malar bone could be distinctly 
moved and crepituR was distinct. Pulse 60. No paralysis. 
Fracture of the malar and superior maxilla with extension of 
lines of fracture through the base of the skull was diagnosti- 
cated. On the second day the patient's condition was very 
much improved but toward evening a rapid rise in temperature 
led to a careful search for the cause of the fever. Professor 
Delafield was called into consultation and found a right lobar 
pneumonia. 

Since leaving the camp I have been informed by Dr. Green- 



234 

leaf that the pneumonia terminated in a typic crisis at the 
usual time, and that the patient is recovering rapidly from the 
injury. 

Case 81. — Charles Lubbas, age 44, German, engineer. Frac- 
ture of the clavicle. A week ago while at work as engineer on 
the Vigilancia, was struck on the right shoulder by a falling 
plank producing a fracture of the clavicle at the junction of 
the outer with the middle third. The fracture was oblique, 
the internal fragment displaced upward and forward and some 
overlapping. Reduction and Sayre-Velpeau dressing. Patient 
was transferred the same day to New York. 

ADDITIONAL CASES OF GUNSHOT INJURIES. 

Case 82. — Peter Carr, aged 40, sergeant Company F, Six- 
teenth Infantry. In service 16 years and nine months. Was 
wounded July 2 before Santiago. He fell down at once on re- 
ceipt of the injury, and on trying to arise found that the left 
leg was paralyzed both as to sensation and motion. He was 
carried to the First Division Hospital where the wound was 
dressed and he remained four days, thence to Siboney where he 
staid three days before being taken on board Hospital Ship 
Relief. He was landed from the Relief at Governor's Island, 
has had a furlough of thirty days and on Sept. 16 reported for 
duty at Camp Wikoff, entering the surgical hospital Sept. 18. 
Examination shows a vigorous looking man with partial paral- 
ysis of left leg. There is a scar on the left side of the back 2% 
inches from the median line and on a level with the second 
lumbar vertebra. This marks wound of entrance of the ball 
there is no wound of exit. The patient says the wound healed 
very promptly with only slight discharge ; further that four 
weeks elapsed before he could rest any weight upon the leg, 
but he has been improving ever since and can now walk with a 
cane. There is marked wasting of the extensor muscles of the 
left thigh and marked impairment of sensation of the left foot 
and leg. He says that occasionally the leg gives way in walk- 
ing, especially if the toe strikes something above the level of 
the ground. He can not raise it when flexed and states that 
with much walking the knee swells. There has been no im- 
pairment of function of bowels or bladder and no priapism. 

In this case the ball probably passed transversely producing 
contusion of the cord and bruising the roots of the spinal nerves 
very near their origin ; it is probably lodged where it will do no 
further harm. The man says the X-ray was used twice but the 
result of examination was not reported to him. 

Case 83. — B. F. Frazier, age 24, Company B, Twenty fourth 
Infantry, has been in the service eleven months. While in 
action July 1, before Santiago, he received a wound of the 
right hand, the bullet entering the web between the index 
finger and thumb, passing through the ball of the thumb and 
making its exit at the base of the adductors over the anterior 



235 

row of carpal bones. No bone injury. The wound was packed 
with gauze. The wound of exit healed in two weeks, the 
wound of entrance has never closed completely and has dis- 
charged from time to time a small quantity of serous pus. The 
patient was admitted to the surgical ward July 15. Examina- 
tion with the probe revealed the presence of a small metallic 
body. During the preparation of the hand for operation a 
small triangular fragment of metal was washed out of the fis- 
tulous opening. Under anesthesia next day the wound was 
again explored and the probe passed to a point underneath the 
scar of the wound of exit, detected another piece of metal 
which was removed by incising the scar, when a fragment of 
lead much larger than the first was extracted. On scraping 
out the fistulous tract with a small sharp spoon shreds of 
gauze were removed. The bullet that inflicted the injury 
must have been a deflected one, as otherwise no fragments of 
lead would have been left in the wound. The gauze undoubt- 
edly belonged to the packing used at the first-aid dressing. The 
wound was dressed in the usual manner ; no provision for 
drainage was made, with the expectation that it would heal 
speedily by primary intention. 

Case 84,— John Marks, age 22, Troop D, Sixth Cavalry, 
enlisted five months ago. He was wounded in the charge on 
San Juan Hill, July 1. The bullet cut the margin of the upper 
posterior edge of the right ear, entered the scalp one inch 
above and one and a half inches behind the right external 
meatus, and emerged from the scalp three inches in a direct 
line from point of entrance, probably making a superficial 
groove in the external surface of the occipital bone. The 
patient says he was.taken to Key West while in an unconscious 
condition, in which he remained two days. July 6 he was 
operated on, the wound being laid bare by a curved incision 
and a small piece of bone is said to have been removed. The 
wound healed in a month. Scars healthy and not sensitive to 
pressure. He complains now of attacks of throbbing pains from 
back of head to eyes, three or four times a week ; the attacks 
last sometimes half an hour. He does not complain of vertigo 
or disturbance of any of the special senses. Whether the 
symptoms are purely of a neurotic nature or whether they 
depend on the injury must be determined by future observa- 
tion. Potassic bromid was prescribed. 

From the above report I have excluded minor cases that 
were treated as out-door patients or inmates of the surgical 
ward not of sufficient interest to have any material bearing on 
the subject of this paper. This communication has been 
written for the special purpose of pointing out to the profes- 
sion, and more especially to the military surgeons, the nature 
and sphere of surgical work in field hospitals at the end of a 



236 



war. This completes my surgical work of this war, and I 
return to civil life grateful to the authorities and my colleagues 
for the kindness and many courtesies I have received at their 
hands. 
General Hospital, Camp Wikoff, Sept. 17, 1898, 



EMPYEMA IN CAMP GEOKGE H. THOMAS. 



The short, decisive campaign with Spain just ended 
tvas characterized, from a medical standpoint, by the 
smallness of the number of those killed in the field, 
the prevalence of disease and the large number of 
deaths from this source. The brilliant victories on 
land and sea which forced Spain to sue for peace have 
cost us so far over three thousand lives — less than 
three hundred from the effects of bullets and over 
two thousand nine hundred from disease. The num- 
ber of deaths from disease will be increased materi- 
ally, as the different military hospitals at home and 
abroad still contain a large number of our sick, many 
of whom will succumb to the diseases contracted dur- 
ing the campaign. Even in case the hostilities are 
not renewed, it is impossible to predict the total loss 
of life at the present time, to say nothing of the 
thousands who will never recover the health they 
brought into the service. The unusual amount of 
sickness which prevailed among our troops, in our 
home camps and at the seat of war, can be attributed 
to various causes. The call to arms came at a time 
of the year when bronchial affections, pneumonia, 
pleuritis and rheumatism are prevalent. In the State 
camp of the Illinois troops cerebro-spinal meningitis 
made its appearance during the first days of their en- 
campment. Typhoid fever had its origin in our State 
camps and followed our army to the National camps 
and to the seat of war in Cuba and Porto Eico. The 
accumulation of large armies and the prolonged en- 
campments in localities which lacked a system of 
sewerage, could not fail in promoting the local spread 
of infectious disease. The invasion of Cuba occurred 
during the rainy season, which had a deleterious effect 



238 

on the health of the unacolimated troops, rendering 
them more susceptible to the effects of the semitrop- 
ical climate and the prevailing diseases. The trans- 
portation facilities for the unloading of the transports 
were utterly defective in furnishing the invading army 
at the proper time with the necessary supplies. The 
clothing of our troops was not adapted for the Cuban 
climate. And, lastly, the necessary precautions to 
protect the troops against yellow fever, which is always 
found on the Cuban coast, where the landing was 
effected, were not carried into effect. The command- 
ing general had been fully advised by the Chief Sur- 
geon of the Army in the Field, but the instructions 
were ignored in the haste and tumult of the brief 
campaign. A lack of a good knowledge of sanitation 
on the part of many of the medical officers, and espe- 
cially the inadequate policing of the camps, had their 
influence in promoting the local spread of disease. 
Amebic dysentery and malaria, the two tropical dis- 
eases to which our troops were exposed in the south- 
ern camps and in Cuba and Porto Rico figured 
largely in the sick and mortality reports. The pre- 
vention of these diseases was beyond the control of 
the medical department. The ordinary camp diarrhea, 
from which almost every participant of the war suf- 
fered to a greater or lesser extent, I am satisfied, did 
much to increase the receptivity of our soldiers to 
typhoid fever infection. 

Another matter of the greatest importance concern- 
ing the health of our troops was the regulation gov- 
ernment ration. The food selected and furnished for 
the army in Cuba and Porto Rico was the same as 
that which had been used in the North. Every one 
who served at the front for any length of time must 
be convinced that the emaciated, starved condition of 
our soldiers who returned from Cuba, and who escaped 
disease, was largely due to the nature of the food upon 
which they had to subsist. The purchase of food at 
the seat of war was out of question. Investigation 
will undoubtedly prove that many of the canned meats 



239 



did not contain the amount of nutriment claimed for 
them. Fresh meat and black bread furnished the 
continental armies are not only more palatable, but 
also more nutritious than the canned meats and hard- 
tack furnished our army. A careful inquiry into the 
kind of food our occupation armies should be fur- 
nished, is one of the most important duties of those 
who are in charge of the commissary department. An- 
other subject of special importance is the special diet 
for the sick. 

It is to be hoped that the medical department will 
be consulted concerning these matters, and that the 
recommendations made will receive the well- merited 
attention of the military authorities. During my 
service, I met one of our soldiers who served under 
General Gordon in his advance on Khartoum, who 
informed me that during that campaign the British 
troops were supplied, on the whole, with much better 
food than was the case in Cuba. England has bene- 
fited by long experience how to conduct a campaign 
in a tropical climate; we are novices in this kind of 
warfare, but have learned enough during the last six 
months to enable us to take better care of our troops, 
should we again be called upon to conduct a war 
beyond the limits of our country. 

I have deemed it appropriate and advisable, in 
accepting your kind invitation to deliver the address 
at this annual meeting, to discuss briefly and from 
the most practical standpoint, a surgical affection 
which I had an opportunity to study in a most satis- 
factory manner during my service at Chickamauga. 
It is my purpose to occupy my allotted time by relat- 
ing my experience with empyema in Camp George 
H. Thomas. I was on duty as chief surgeon in that 
camp for nearly four weeks during the months of May 
and June. During that time the camp was occupied 
by nearly 40,000 men, representing nearly all of the 
States east of the Rocky Mountains. With the excep- 
tion of one company of cavalry on guard duty, the 
army was composed entirely of volunteers. The days 



240 

were hot, the nights cool ; the midday temperature 
frequently reached 98 to 100 degrees F. The drouth 
which prevailed at that time rendered the roads dusty, 
the clouds of dust being only settled occasionally by 
showers of short duration. Camp diarrhea, dysen- 
tery, cerebro- spinal meningitis, pneumonia and ty- 
phoid fever were then the principal diseases we had 
to contend with. 

It is one of the complications of pneumonia — 
empyema — as observed in Camp Greorge H. Thomas, 
that I desire to discuss this evening. Empyema rep- 
resents the pathologic product of suppurative pleu- 
ritis. Suppurative pleuritis is always the result of a 
pyogenic infection of the pleura sufficient in virulence 
to give rise to pus formation. In the absence of 
traumatic causes it appears clinically and patholog- 
ically either as an isolated inflammation of the pleura 
or as a more or less remote complication of pneu- 
monia. Bacteriologically speaking, suppurative pleu- 
ritis can only result from the presence in and the 
specific action upon, the tissues of the pleura of pyo- 
genic microbes in sufficient number and virulence to 
give rise to a suppurative inflammation. 

Non- traumatic, suppurative pleuritis is a compara- 
tively rare, isolated affection; in the great majority of 
cases it presents itself as a complication of pneu- 
monia. Recent investigations tend to prove that the 
essential cause of pneumonia is either Frankel's pneu- 
mococcus, Friedlander's bacillus of pneumonia (dip- 
plo-bacillus) or the streptococcus pyogenes. Strep- 
tococcus pneumonia, occurring either as a primary or 
secondary affection, is characterized clinically by the 
gravity of the disease and pathologically by the 
tendency to pus formation. The microbes of pneu- 
monia discovered and described by Frankel and 
Friedlander are the bacteriologic agents usually 
found in the inflamed tissues in croupous pneumonia. 
Both these microbes possess feeble intrinsic pyogenic 
properties, and when, during the pneumonic process, 
abscess formation or suppurative pleuritis sets in, the 



241 

complication occurs usually as the result of a second- 
ary or mixed infection with pus microbes. Croupous 
pneumonia is a self-limited disease, and when febrile 
symptoms persist after a sufficient time has elapsed 
for the disease to complete its typic cycle, it is usually 
an indication that mixed infection has occurred, and 
in this event it becomes the urgent duty of the 
attending physician to look for, locate and determine, 
if possible, the nature of the complication to enable 
him to institute timely, appropriate therapeutic 
measures. 

In suppurative pleuritis complicating pneumonia, 
the inflamed lung tissue is seldom involved in the 
suppurative process. Resolution may proceed in a 
satisfactory manner at the time and after the suppu- 
rative pleuritis has set in, a fact which would tend to 
prove that the parenchyma of the lung is more resist- 
ant to the action of pyogenic microbes than the 
tissues of the pleura, or that these microbes find their 
way more readily to the pleura than into the pneu- 
monic focus after secondary infection has occurred. 
The complicating secondary pleuritis manifests itself 
usually about the time the crisis is expected or a few 
days later. It is evident that suppurative complica- 
tions in cases of pneumonia would be likely to appear 
in cases in which the tissues are rendered suscepti- 
ble to the action of pus microbes and under circum- 
stances which would supply the bacteria for the sec- 
ondary, mixed infection. 

Both these conditions were present and operative 
in Camp Greorge H. Thomas. The health of many of 
the men encamped at Chickamauga was impaired 
soon after reaching camp by the sudden climatic 
changes, change of food, malaria and camp diarrhea. 
Nearly all cases of pneumonia were characterized by 
the gravity of the symptoms and a tardiness with 
which resolution occurred. Camp Thomas was 
located on the government reservation ten miles 
south of Chattanooga. The ground is undulating and 
in part well wooded. Numerous clearings and open 



242 

spaces furnished excellent facilities for the drilling 
and maneuvering of the troops. The National Park 
is traversed by a sluggish stream, the Ohickamauga. 
Three regiments of cavalry and a number of batteries 
were in camp during the month of June, the time 
the five cases of pneumonia complicated by empyema 
came under my observation. The ground is inter- 
sected by numerous roads which during the season of 
drouth which prevailed at that time, became covered 
with inches of fine dust, which by driving of innu- 
merable vehicles of all kinds, the marching of troops, 
the passage of cavalry and artillery would rise in 
dense clouds and by sudden gusts of wind would often 
cover the entire camp. This dust was contaminated 
by pathogenic microbes of all kinds, which could not 
fail in finding their way into the air-passages of the 
occupants of the camp. The dust was most abundant 
near the roads on which there was the most travel, 
that is, near headquarters. 

It was not strange that most of the cases of pneu- 
monia originated in localities where the dust clouds 
were densest, filling the tents and kitchens and cov- 
ering the food supplies. The dust had undoubtedly 
some influence in the causation of pneumonia, and 
more particularly in determining the frequency with 
which it was attended or followed by suppurative 
pleuritis. 

Many of the soldiers left their State camps affected 
by bronchial catarrh, which constituted a potent pre- 
disposing cause to pneumonia. This was particularly 
true of some of the regiments from Illinois. Natu- 
rally the first regiments arriving at Camp Thomas 
were quartered near the great thoroughfares of travel 
and those arriving later in more remote parts of the 
camp. It is a noteworthy fact that those regiments 
farthest away from headquarters were almost free 
from pneumonia, while those nearest the center of 
travel furnished the largest number of cases. The 
cool nights, the lying on the moist ground and the 
inadequate supply of blankets did their share in serv- 



243 

ing as potent exciting causes. Some definite infor- 
mation in reference to the distribution of the disease 
can be gained by considering the location of the divi- 
sion hospitals, and the number of cases of pneumonia 
treated in each one of them. The division hospitals 
were located as near the center of the respective divi- 
sions as possible. 

The First Division Hospital was established on the 
Lafayette Road, about three-quarters of a mile from 
the headquarters of the corps. The Second Division 
Hospital was established about two miles from head- 
quarters and about one-quarter of a mile from any 
principal thoroughfare, the Brotherton Road being 
the nearest one. But few of the regiments of this 
division were encamped on roads subject to much 
travel. 

The Third Division Hospital was located at the 
junction of the Alexanders Bridge Road and the Jay's 
Mills Road, about two miles from headquarters. Some 
of the regiments of this division were quartered on 
roads which were used by the wagon trains hauling 
water, consequently frequently exposed to clouds of 
dust. 

During the latter part of May and the month of 
June forty- six cases of pneumonia developed in the 
First Army Corps. These cases were distributed 
among the division hospitals as follows: Hospital at 
Headquarters, 4 cases; First Division Hospital, 32 
cases; Third Division Hospital, 10 cases. The Second 
Division Hospital was not established until the mid- 
dle of June, and from that time on until the end of 
the month not a single case of pneumonia was 
reported. Careful inquiry at the regimental hospi- 
tals failed in finding a case previous to the establish- 
ment of the division hospital. This was the division 
encamped almost entirely away from any of the prin- 
cipal roads, hence least subjected to dust-infection. 
It will be noticed that 32 cases, or nearly 70 per cent, 
of the entire number, occurred in the First Division 
regiments. Out of these forty-six cases six died, or a 



244 

mortality of 13 per cent. The six fatal cases came 
from the First Division. In three of these fatal cases 
death was caused by the progressive extension of the 
septic pneumonia, and in the remaining three death 
was caused by complications. In one case death was 
attributed to a typhoid condition; in two to cerebro- 
spinal meningitis. The septic nature of the cases of 
pneumonia which developed in the First Division is 
best shown by the frequency with which empyema 
attended or followed the pulmonary disease. In this 
division empyema complicated the pneumonia in nine 
out of the entire number of thirty-two cases, equal to 
28 per cent. Four of these cases were treated at the 
Leiter Hospital and four at the St. Vincent's Hospi- 
tal, Chattanooga. Five of these cases were operated 
upon by myself : four at the St. Vincent's Hospital 
and one at the Leiter Hospital. The following case 
represents the pathologic conditions found in these 
cases as well as the surgical treatment which was 
resorted to in meeting the indications of the empy- 
emic complication : 

W. F., private, Third Ills. Vols., was taken suddenly ill 
while on drill, May 30. The attack was initiated by nausea, 
vomiting, dizziness and a sense of great prostration. On the 
following day severe diarrhea set in, which, in connection with 
persistent vomiting and intense headache, influenced his phy- 
sician to transfer him to the division hospital. At that time 
physical examination revealed a well-marked bronchitis. In 
the evening he had a decided chill ; temperature 103. 

June 1 he complained of severe pains in his chest and back, 
cough dry and hacking, sputum tinged a rusty color. Diar- 
rhea continues ; slight delirium ; temperature 99 in the morn- 
ing, 103 in the evening. 

June 2. Chest pains not relieved, sputum more deeply 
tinged. Temperature varies from 101.5 to 103. 

June 3. Diarrhea under control ; cough and expectoration 
unchanged ; delirium and temperature about the same. 

June 4. No material change in the condition of the patient ; 
tongue dry and dark brown. 

Daily examinations of the chest did not reveal any signs of 
consolidation of the lung until June 6. At this time the mid- 
dle and a part of the upper lobe of the right lung were found 
consolidated. Temperature 102. 

June 7. Patient delirious most of the time ; cough narass- 



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246 

iog, and copious expectoration of rusty sputum. Temperature 
rose rather suddenly to 105. 

June 8. Cough less troublesome, sputum more scanty ; sub- 
jective symptoms improved. Patient was transferred to the 
Leiter General Hospital, when on his arrival the temperature 
was found to be 102.4. The medication at this time consisted 
of strychnia in small doses, muriate of ammonia 5 grains every 
four hours, alternated with 3 drops of turpentine. Under this 
treatment the temperature was reduced 1% degrees during the 
first day, 2 degrees the second, and 1% degrees the third day, 
becoming normal June 11. Carbonate of ammonia was sub- 
stituted for the muriate at this time. 

From June 12 to 18 the temperature ranged one degree above 
and below normal. The pulse, which had been 118 beats per 
minute and feeble on his admission to the Leiter Hospital, 
became fuller and stronger and diminished in frequency to 80. 

June 19. Temperature suddenly rose in the afternoon to 
102, pulse 96. 

June 20. Examination of chest showed absolute dulness on 
the right side, extending as high as the fourth rib. The 
appearance of fever after a few days of complete defervescence 
and the rapid increase of the area of dulness, displacement 
of the apex- beat to the right, as well as a marked bulging of 
the lower intercostal spaces, left no doubt of the existence 
of empyema. The symptoms indicating the presence of 
this complication were so evident that it was not deemed 
necessary to resort to an exploratory puncture to verify the 
diagnosis. 

In all of the cases of pneumonia complicated by 
empyema that came under my personal observation, 
the disease pursued a very similar course to the one 
described. The clinical symptoms were characterized 
by their severity. The patient's general condition 
left little doubt as to the septic nature of the original 
disease. As in the case detailed, the suppurative 
pleuritis commenced tv^o to three days after the pneu- 
monic symptoms had subsided, its onset being 
announced by a rise of temperature and the appear- 
ance of local and general symptoms, suggestive of the 
existence of a suppurative aflPection. 

It is more than probable that in most of these cases 
the pyogenic microbes, which eventually attacked the 
pleura and caused the suppurative process, entered 
the lungs at the same time and in the same manner 
as the microbes which caused the pneumonia. The 



247 

bronchitis and diarrhea which initiated the disease 
were plain evidences pointing in this direction. In 
some of the cases in which the pneumonia pursued a 
more typic course, the subsequent suppurative pleu- 
ritis was caused by a secondary mixed infection. All 
cases of empyema which were subjected to operative 
treatment were characterized pathologically by the 
presence of an abundant fibrinous exudate, which 
covered both the visceral and parietal pleurae, and, in 
the form of large fibrinous masses, mixed with the 
thick cream-like pus. The purulent accumulation 
occurred rapidly, filling the pleural cavity in a very 
few days. Displacement of the heart, enlatgement of 
the chest and bulging of the intercostal spaces were 
the most significant local signs indicating the pres- 
ence of a large quantity of pus in the cavity of the 
chest. The right and the left sides were affected with 
about the same frequency. In one case the pleuritis 
was limited, leading to a circumscribed empyema in 
the left side. The abscess occupied the lower and 
posterior part of the chest. In performing the rad- 
ical operation in this case, a section of the tenth rib, 
about three inches from the spinal end, had to be 
excised. The location of the empyema was deter- 
mined beforehand by systematic exploratory punc- 
tures, the first two punctures yielding negative evi- 
dence. As a rule, expansion of the compressed lung 
followed soon after the operation, showing that reso- 
lution had occurred before or after the pleuritic com- 
plication appeared. 

In some of the cases suppuration was scanty after 
the operation; in others it was abundant. In the 
former event a process of repair set in promptly ; in 
the latter case it was retarded. The final process of 
obliteration of the pleural cavity was accomplished by 
granulation, cicatrization and cicatricial contraction. 
Evacuation of the pus and drainage were always fol- 
lowed by a fall in the temperature to normal, or 
nearly so, accompanied by symptoms denoting rapid 
improvement of the patient's general condition. In 



248 

two of the oases the physicians in attendance were 
misled in their diagnosis by the absence of fever. 
The pleuritis was initiated as usual by a rise in tempera- 
ture and other febrile disturbances, which subsided in 
a few days, the patients feeling well with the excep- 
tion of the complaint of embarrassment of the respi- 
ration. In one case the respiration was so much 
interfered with by the copious pleuritic exudate that 
the lips were blue and the pulse almost imperceptible 
— conditions which necessitated the performance of 
the operation without an anesthetic. We relied in 
this case on strychnia and whiskey to counteract the 
immediate effects of the operation. In the absence 
of such contraindications ether was used as an anes- 
thetic, aided by the administration of some heart 
stimulants immediately before the administration of 
the anesthetic. 

OPEKATION FOR EMPYEMA. 

The existence of an empyema in the adult is a suffi- 
cient indication for the performance of a radical ope- 
ration. Puncture and removal of the pus by aspira- 
tion may succeed occasionally in mild cases of sup- 
purative pleuritis in the case of children; seldom, if 
ever in the adult. Operative treatment should be 
instituted as soon as a diagnosis can be made. Unless 
the signs and symptoms are conclusive, the diagnosis 
should be verified and the pus accurately located by 
an exploratory puncture, as was done in most of the 
cases operated upon in Camp Thomas. Nothing is 
gained and much is lost by postponing surgical treat- 
ment until the accumulated pus has increased to the 
extent of producing serious and often irremediable 
compression of the lung on the affected side. The 
plastic exudate, which is often copious, as in all the 
. cases forming the basis for this address, is another 
source of danger in case the operation is not promptly 
performed, as it creates conditions unfavorable to the 
subsequent expansion of the compressed lung and 
extenuates indefinitely the infection. 



249 

In view of the pathologic anatomy presented by 
the cases of empyema which constitute the basis for 
this paper, it must be admitted that the only rational 
treatment consists in opening the pleural cavity freely 
and in establishing efficient tubular drainage. Inter- 
costal incision and drainage do not enable the sur- 
geon to remove the large fibrinous masses which play 
such an important role in maintaining suppuration 
and in preventing speedy obliteration of the pleural 
cavity. The fibrinous exudate contains pus microbes, 
and unless removed at the time the operation is per- 
formed, serves as a nutrient medium for their growth 
and reproduction and interferes mechanically with 
pulmonary expansion and speedy obliteration of the 
pleural cavity by granulation and cicatrization. One 
of the important modern indications in the surgical 
treatment of empyema is to remove the inflammatory 
product as thoroughly as possible, and this can only 
be done after opening the cavity sufficiently to remove 
by mechanic measures the infected exudate. In 
recent cases resection of two "inches of one rib at a 
point where drainage will be most effectual will afford 
sufficient room to subject the pleural cavity to a thor- 
ough removal of the inflammatory exudate. With 
the exception of the case of circumscribed empyema, 
we opened the chest in the axillary line where the 
ribs are nearest the skin and usually resected the 
seventh rib. With one exception, aspiration was per- 
formed a day or two before the operation for the pur- 
pose of securing partial pulmonary expansion before 
admitting air into the pleural cavity. 

Preliminary aspiration is of special value in the 
treatment of large empyemic cavities. The surface 
of the entire chest was thoroughly disinfected and 
every care taken to carry out full aseptic precautions 
during the operation. The opening of large pus 
cavities is attended by great responsibility, and this is 
more especially true in empyema, as secondary infec- 
tion is liable to occur unless the operation is per- 
formed under strictest aseptic precautions. If an 



250 

anesthetic is given, the greatest watchfulness is re- 
quired to guard against accidents. I always prefer 
to perform the operation under partial anesthesia, and 
I am very partial to strychnia and alcohol as valuable 
adjuncts in minimizing its immediate and remote 
dangers. 

I place the patient partially on the opposite side 
with the chest slightly raised, and the arm on the side 
to be operated upon raised to the side of the head for 
the purpose of increasing the width of the intercostal 
spaces. I expose the rib to be resected by a slightly 
curved incision with the convexity directed downward, 
beginning the incision at a point corresponding with 
the upper border of the rib, carrying it in a gentle 
curve to the lower border, and terminating it at the 
upper border at a point about four inches from where 
it started. By reflecting the cutaneous shallow, oval 
flap in an upward direction, the muscular covering of 
the rib is exposed. A straight incision over the cen- 
ter of the rib, about three inches in length, is then 
made down to the bon^. With an elevator the peri- 
osteal envelope with the tissues attached to it is then 
separated, taking care to lift out from its groove the 
intercostal artery with the tissues to be reflected. 
After laying bare the rib to the extent of at least two 
inches, the rib is lifted forward with the elevator and 
excised with a strong pair of bone- cutting forceps. If 
the diagnosis is positive, all that remains is to make 
an incision with the scalpel in the center of the peri- 
osteal trough, large enough to admit the tip of the 
index finger. 

The evacuation of the chest contents should always 
be done slowly; this can be done most effectually by 
interrupting the flow of pus from time to time by in- 
serting the index finger into the pleural incision. After 
evacuation of the pus and loose shreds of fibrinous 
material, the pleural cavity should be carefully exam- 
ined by direct inspection and digital exploration. 
Plastic exudates attached to either pleura must be 
removed as thoroughly as can be done with finger and 



251 

a small gauze sponge held securely in the jaws of a 
pair of long, preferably slightly curved, forceps. The 
membranes should be removed by mopping and not 
by the use of sharp instruments. Scraping of the 
pleurae with a sharp spoon is superfluous and occa- 
sionally detrimental. In acute cases I have often 
noticed quite free hemorrhage from the pleural sur- 
faces even after gentle efforts to dislodge the adherent 
fibrinous exudate. Should troublesome hemorrhage 
follow the procedure, packing of the pleural cavity 
with one long strip of plain sterile gauze should at 
once be resorted to. The space below the drainage 
opening is packed first, and if the hemorrhage is not 
arrested, the balance of the cavity is packed from 
above downward. 

Tubular drainage is the ideal method of draining a 
suppurating pleural cavity. I use for this purpose 
two fenestrated tubular drains, the size of the little 
finger, about four inches in length and securely fas- 
tend together with a large safety-pin. Drains have 
been repeatedly lost in the pleural cavity for want of 
resorting to this simple precaution. After inserting 
the tubular drain, the external wound is sutured in 
the usual manner. The curved incision, as described 
above, not only exposes the ribs more freely than the 
straight incision, as usually practiced, but it is also 
much better adapted for prolonged drainage. 

I never irrigate the pleural cavity the day the oper- 
ation is performed. I do so later, provided suppura- 
tion continues. In case irrigation of the pleural cavity 
becomes necessary, care is necessary in the selection of 
the antiseptic solution; carbolic acid and corrosive sub- 
limate in the usual strength are dangerous, and should 
never be used. I make use of either a saturated solution 
of the acetate of aluminium or Thiersch's solution. 
Both of these solutions are efficient as an antiseptic and 
non- toxic even when used in large quantities. The value 
of the double drain is made apparent when it becomes 
necessary to irrigate the pleural cavity. By placing 
the patient on the opposite side, the fluid which enters 



252 

the chest through one tube escapes through the other 
as soon as the cavity is full, thus washing it out thor- 
oughly. By placing the patient on the affected side 
the cavity is emptied, when the same procedure is 
repeated until the solution returns clear. The solu- 
tion used should always be heated to blood tempera- 
ture, as irrigation with a cold solution is fraught with 
danger. 

The external dressing should consist of a thick 
cushion of sterile gauze and absorbent cotton to 
absorb the fluid as fast as it escapes, and to provide 
the wound with a filter to prevent post-operative in- 
fection. The best way of keeping the dressing in 
place and to prevent the entrance of unfiltered air 
into the cavity, is to substitute for the ordinary band- 
age the rubber webbing bandage. Change of dressing 
and antiseptic irrigation become necessary as often as 
the dressing becomes saturated. For the purpose of 
obviating frequent changes, the dressings should be 
ample. 

As the cavity diminishes in size the drains are 
shortened from time to time, and sooner or later one 
of them can be dispensed with. Premature removal 
of the drain is often followed by relapse. Drainage 
must not be suspended until the surgeon can satisfy 
himself by careful examination that the pleural cavity 
has become obliterated. 

Should the lung fail to expand sufficiently in the 
course of a few months to place the cavity in a condi- 
tion for definitive healing, Schede's thoracoplastic 
operation is the operation of choice, as Estlander's 
multiple rib resection has not yielded the expected 
results in the practice of many operators, including 
my own. It is well for the surgeon to keep close 
watch of the size of the cavity during the after-treat- 
ment. It has always been my custom, at stated inter- 
vals, to place the patient on the opposite side, then 
fill the cavity with one of the antiseptic solutions used 
for irrigation, then evacuating the chest by reversing 
the position and measure the quantity of fluid re- 



253 

moved. By recording the results of such measure- 
ments, we are in a position to judge with mathematic 
precision the size of the cavity, and determine whether 
or not healing is possible without further and more 
serious operative interference. Prompt and progres- 
sive improvement followed the operation in all of my 
cases of empyema operated upon in Camp Thomas. 
In most of the cases suppuration was soon under con- 
trol, followed by speedy pulmonary expansion and 
permanent healing of the empyemic cavity by granu- 
lation. In two of the cases a recent examination 
made by Dr. A. F. Lemke showed that the patients 
recovered their former health. 

Our limited means of making a satisfactory bacte- 
riologic examination of the inflammatory product 
made it impossible to ascertain in each case the nature 
of the microbic cause of the suppurative complica- 
tion. In two of the cases, inoculation of proper 
nutrient media resulted in an abundant growth of the 
staphylococcus pyogenes aureus. I have but little 
doubt that in most, if not in all cases, the suppura- 
tive pleuritis developed in consequence of a secondary 
infection with pus microbes, probably in most instan- 
ces with the staphylococcus, as indicated by the clin- 
ical course of the disease and the nature of the 
inflammatory product. The etiologic relationship of 
dust to pneumonia, and especially the pleuritic com- 
plication, must be regarded as established by the facts 
related above. 

The influence of dust in the causation of pneumo- 
nia and suppurative pleuritis acts in two ways in the 
causation of these diseases: 1. The mechanical irri- 
tation of the bronchial mucous membrane resulting 
from the presence of ordinary dust renders the epi- 
thelial layer of the bronchial mucous membrane more 
permeable to the entrance of pathogenic microbes. 
2. Pathogenic microbes, and in this case pus microbes, 
are suspended in the dust and find with it entrance 
into the air-passages. 

The importance of early radical operative inter- 



254 

vention in the treatment of empyema can not be 
overestimated. The only efficient treatment in such 
cases consists in opening the cavity of the chest freely 
by rib resection, removal of inflammatory product and 
establishing free tubular drainage, followed by safe and 
efficient irrigation, should subsequent suppuration 
demand it. 



ESCULAPIUS ON THE FIELD OF BATTLE, 



Esculapius on the field of battle ! What an inspir- 
ing sentiment at this time and on this occasion! Escu- 
lapius, the fabled deity of medicine, engaged on the 
battlefield in directing his faithful disciples in bring- 
ing comfort to the dying and timely and efficient aid to 
the wounded, is indeed an idea conveying the loftiest, 
noblest, soul- inspiring subject. The disciples of Escu- 
lapius have followed and served every army since man 
has resorted to contest by force of arms to secure the 
real or imaginary rights of tribes and nations. Every 
battlefield bears testimony of their life-saving, human- 
itarian work. When battles were fought hand-to-hand, 
and by the use of the most primitive weapons of war, 
the Esculapians were there with their pots of boiling 
oil with which to stanch bleeding, with their crude 
instruments with which to extract arrows buried in 
the flesh of the wounded warriors, and with their 
bottles of wine and oil with which to dress the wounds. 
Their practice has kept more than pace with the rapid 
and wonderful improvements in the implements of 
destruction employed on the battlefield. 

It is a long time since civilized nations abandoned 
the catapult for the cannon, and the small- caliber, 
repeating breech-loader has taken the place of the 
bow and arrow, but the disciples of Esculapius have 
more than counterbalanced the increased horrors of 
war by the marvelous advancements made in the sci- 
ence and art of surgery. The battlefield has witnessed 
many changes in the practice of military surgeons. 
It was on the battlefield that Ambroise Pare substi- 
tuted the ligature for the cautery in arresting hemor- 
rhage. It was on the battlefield that Hans Ryf, Baron 
Larrey, Pirogofif, Guthrie, Nussbaum, Langenbeck, 



256 

Esmarch, Stromeyer, Billroth, and a host of other 
worthy priests in the temple of Esoulapius, achieved 
lasting fame. 

Conservative surgery is the pride of the modern 
Esculapian on the field of battle. The stacks of 
amputated limbs that constituted such a gruesome 
and constant sight after every great battle during the 
Civil War, will never be seen again on the field of 
battle where modern surgery is practiced. Aseptic 
surgery has driven out of our military hospitals the 
four greatest enemies of the wounded soldier: hospi- 
tal gangrene, secondary hemorrhage, pyemia and ery- 
sipelas. The probe, an instrument of torture, danger 
and fallacy, has been abandoned for the X-ray in 
locating bullets lodged in the body. The first-aid 
dressing properly applied at the right time constitutes, 
in the vast majority of cases, almost a sure protection 
against infection of the wound. Under aseptic pre- 
cautions penetrating gunshot wounds of the large 
joints heal promptly, often without serious impair- 
ment of the function of the joint. Many cases of 
penetrating wounds of the chest and abdomen re- 
cover without operative interference. Prophylaxis has 
largely taken the place of operative surgery in the 
field. Our recent experience in Cuba and Porto Rico 
has demonstrated that the small-caliber rifle is a most 
humane weapon. If the wounded survive the imme- 
diate efifects of the injury the prospects of recovery 
are good. Most of the wounds of the soft parts out- 
side the three large cavities healed, with few excep- 
tions, under one dressing in from ten days to three 
weeks. What a contrast with the experience of the 
surgeons during the Civil War only thirty-five years 
ago! This wonderful improvement in military sur- 
gery has been brought about through the labors of 
the disciples of Esculapius during the last thirty 
years. 

Esculapius is unselfish and impartial in his work. 
His deeds of mercy are dispensed alike to friend and 
foe. He knows no creed, no politics. He is on the 



257 

side of wrong as well as justice. He is loyal to every 
flag hoisted on the field of battle. He rejoices with 
the victorious, he sympathizes with the vanquished. 
He loves and respects the uniform of every nation. 
He is not anxious for war, but when war does come 
he is promptly on the field and remains there as long 
as a single soldier requires his services. He never 
sleeps. His thoughts, his actions, are devoted to the 
welfare and usefulness of the soldier. He is the 
adviser of the well, the comforter and physician of 
the sick and the good Samaritan of the wounded. His 
disciples have always proved worthy of their noble 
profession when engaged on the field of battle. They 
have served on every battlefield without any prospect 
or expectation of achieving undying fame, or even 
receiving the gratitude due them from those benefited 
by their services. Our histories of the world bristle 
with accounts of heroism and daring exploits of fam- 
ous generals, but how liitle do we find of praise of 
the deeds of the disciples of Esculapius who faced all 
the dangers incident to warfare, besides doing battle 
daily with the Grim Reaper behind the fighting line. 
The Esculapians on the field of battl6 belong to a 
noble, unselfish, learned profession. It requires years 
of hard study and a small fortune to acquire the nec- 
essary knowledge to prepare them for their work. 
They are men who in civil life would occupy a high 
social position and enjoy a handsome income from the 
practice of their profession. But the medical profes- 
sion of all countries has always been intensely patri- 
otic in times of war. The doctors always have been 
and always will be the salt of the population. Their 
education and training are of a nature to ensure qual- 
ities necessary to citizenship of the highest type. The 
practice of their profession, even in times of peace, 
is admirably adapted to prepare them for the emer- 
gencies of war. In the exercise of their dutieS they 
encounter dangers and hardships foreign to the lives 
of the average citizens. They brave epidemics far 
worse than bullets, as far as danger to life is con- 



258 

oerned, without fear of death. In cities devastated 
by the scourge of yellow fever or cholera, when every- 
body else that can leaves for a place of safety, the 
doctors remain at their posts and minister to the sick 
and dying without any expectation of a substantial 
reward, or even the gratitude of their impoverished 
clients. Day after day and night after night the 
familiar modest conveyance, with its lonely occupant, 
can be seen in the depopulated streets, wending its 
way to the hovels of the poor on its errand of mercy. 

No military surgeon has ever attained the fame of 
the innumerable heroes who distinguished themselves 
on the battlefield and whose deeds have been immor- 
talized in prose and poetry. In rank, pay and social 
position he has always been at a disadvantage as com- 
pared with the leaders of armies. His greatest reward 
always has been, and probably always will be, the 
consciousness of having performed his duty to his 
fellow- men. Will you not agree with me that the 
doctrines as taught by Esculapius and as practiced by 
his disciples are akin to the teachings of the Great 
Master? If you do not, let us follow for one day and 
one night the work of our Esculapian on the modern 
battlefield. 

The disciple of Esculapius is on the field before 
the expected battle. He is a non-combatant and mod- 
estly takes his place behind the fighting line. He 
knows what is expected of him during the next day, 
and makes the necessary preparations. During the 
night the troops are rushed to the front and the line 
of battle is completed. A deadly silence attends these 
preliminary preparations for the next day's conflict. 
Prom the commanding general down to the private a 
sense of responsibility, uncertainty and suspense pre- 
vails. With the dawn of the new-born day the deadly 
conflict begins. The batteries furnish the prelude to 
the impending battle, followed by the irregular flring 
of the picket lines. The more regular cannonading 
on both sides and the volleys of musketry announce 
that the day's bloody work has begun in earnest. 



259 

The uproar and tumult of battle has commenced. The 
line of battle is advancing slowly. Our Esculapian 
disciple is not idle for any length of time. He is near 
enough the fighting line to observe the movements of 
the troops, and within range of the fire. The singing, 
whizzing bullets do not disturb his calmness. Shells 
plow the ground around and about him, exploding 
with a dull but terrific noise and sending their mes- 
sengers of death in all directions. He takes position 
in a sheltered place, where his patients will find pro- 
tection from the fire of the enemy. 

He is hardly ready for his day's work when the first 
victim arrives. He has been conveyed to the rear by 
friendly hands. A hasty examination shows that he 
has been shot through the thigh. The trousers on 
the injured side are soaked with blood. The garment 
is removed and a stream of red blood locates the bul- 
let-wound. The patient's face presents a deadly pallor, 
his forehead is covered with a cold, clammy perspira- 
tion. The hands are cold and the pulse at the wrist 
is almost imperceptible. It is evident that the bullet 
has injured a large blood-vessel and that life is rapidly 
ebbing away from hemorrhage. The patient is con- 
scious, but passive and listless. He does not realize 
his own danger. AH he complains of is a torturing 
thirst and all he asks for is a drink of cold water. The 
experienced eye of the surgeon takes in the whole 
situation at a glance. He knows that prompt action 
is necessary to ward off impending death. In less 
time than is necessary to describe it, he applies an 
elastic constrictor above the wound which arrests the 
bleeding promptly, makes use of the first-aid package 
to protect the wound against infection, administers 
the necessary restoratives, pins the diagnosis tag to 
the lapel of the uniform, satisfies his thirst by admin- 
istering the contents of his own canteen, and hands 
the patient over to the hospital- corps men, who bring 
him safely to the ambulance station. 

Before he has disposed of his first charge his ser- 
vices are urgently demanded in his immediate vicinity. 



260 

and he hastens to the new scene of catastrophe. A 
young soldier has been struck down by a fragment of 
a bursting shell which has almost completely severed 
both legs just below the knee-joint. The patient lies 
on the ground, motionless, with his sunken eyes di- 
rected stolidly toward the overhanging blue sky. He 
has lost but little blood, but his lips are pale and 
slightly livid, the nostrils dilated, the skin of the fore- 
head thrown into deep folds. The hands are cold and 
the pulse at the wrist can not be felt. The respira- 
tions are irregular and sighing ; a long and deep res- 
piration is followed by a number of shallow, imper- 
fect expansions of the chest. The mind is clear, but 
it takes repeated questions to elicit the simplest 
answer. The unearthly brilliancy of the otherwise 
expressionless, staring eyes clearly indicates the inev- 
itable doom that awaits the wounded warrior. His 
life is but the flickering light of a tallow candle to be 
extinguished at any moment. The surgeon knows 
that in this case the terrible injury will result in death 
from shock. The patient is ignorant of the extent 
of the injury sustained, and if he should happen 
to see the cold, mangled, motionless legs, almost 
detached from the body, he would not realize that 
his life is in such immediate jeopardy. He makes no 
complaint and no requests. In an almost inaudible 
whisper he may ask for a drink of water. Home, 
relatives and friends have become to him but a pleas- 
ant dream. His mind is occupied by the experience 
of the day, his ears are filled with the din and tumult 
of battle, his eyes are still resting on yonder line of 
battle he was approaching but a few minutes ago with 
a firm hope of victory when he, with several comrades, 
was mowed down by the bursting shell. 

The conscientious surgeon, recognizing the hope- 
lessness of the case, feels that he has another mission 
to perform. He ascertains the name of the wounded 
and of the nearest relatives, and the address, and then 
calmly informs his patient of what awaits him. For 
a moment such information brings the patient's mind 



261 

back to realities and, probably with a smile and look 
of gratitude, he responds calmly to the questions. He 
is made as comfortable as can be done under the cir- 
cumstances, but before the setting of the sun his 
spirit has left the mutilated body and joined the 
peaceful army beyond the reach of human warfare. 
The next mail carries with it a letter from the sur- 
geon, in which he details the date and cause of death 
of the gallant dead to his distant relatives. What 
such letters from the battlefield, conveying the last 
message of the dying soldier, mean to the relatives, 
can only be fully realized by those who have received 
them. 

As the heat of battle rises the number of wounded 
increases rapidly. At the first dressing station they 
are lying, sitting, standing, walking, awaiting the first 
dressing. Our Esculapian is unmindful of the heat, 
thirst and hunger, and hastens from soldier to soldier 
to extend to as many as possible, and in the shortest 
space of time, the blessings of the modern first-aid 
dressing. 

With the approaching twilight firing gradually 
ceases, without any definite decision of the fortunes 
of war on either side. On both sides the soldiers rest 
on their arms, and under the cover of darkness satisfy 
hunger and thirst. Tired to death from the day's 
conflict, sleep overtakes them and the naked earth is 
coveted as a luxurious couch. The work of the com- 
batants has ceased for the day; that of the non- 
combatants now begins in earnest. Many of the 
wounded still remain on the ground, bleeding and 
suffering from pain and thirst. The veil of darkness 
is penetrated in all directions in search of them. The 
faint voices here and there serve a useful purpose in 
locating them. The dead remain where death reached 
them. Many a litter-bearer's steps are made uncer- 
tain by stumbling over the corpses which cover the 
field. The crowd of wounded behind the fighting 
line, at the ambulance station and in the field hospi- 
tals grows larger and larger, and the cries for surgical 



262 

aid become louder and more and more imploring. Can 
the surgeon who has worked incessantly all day quiet 
his conscience and satisfy nature's demand for rest, 
follow the example of his combatant comrades, throw 
himself on the ground and seek repose by surrender- 
ing himself to the greatest of all charmers — sleep? 
No! As long as his brain will do its duty and as long 
as a single muscle will respond to his determined will 
power, he will serve the wounded. 

There are cases in which a prompt primary opera- 
tion will save life. These are the cases who receive 
his first attention. An operating-table is extempo- 
rized, assistants are pressed into service, and with the 
aid of a candle light the most difficult operations are 
performed in the silence of the night, broken only by 
the frequent meanings of the numerous wounded 
waiting their turn for the operating tent, mingled 
from time to time with the shrieks of those who have 
become raving maniacs, and the stertorous breathing 
of the dying. What an awful night for our poor 
Esculapian who forgets his own wants and strains 
every nerve to serve his fellow-men, and to do credit 
to his profession and the country and flag that he 
calls his own. Throughout the whole night he works 
faithfully and incessantly, and with the break of day 
he finds his task still unfinished, and the prospects 
stare him in the face of a repetition of the previous 
day's experience. The day work was hard and trying; 
the night work reached the limits of human endurance. 

Can you give me a more striking example of genu- 
ine patriotism and heroism than the twenty-four hours' 
work performed by our disciple of Esculapius on the 
field of battle? If you can not, I can. It is the same 
Esculapian away from the bloody field in the fever 
camp. It requires courage to face the enemy on the 
field of battle. It requires courage to stand up in a 
rain of bullets and in an atmosphere torn asunder every 
few moments by shot and shell, but it requires more 
courage to enter the silent fever camp, v/ith its myri- 
ads of invisible foes. The song of the bullet is sweet 



263 

music compared with the silent, invisible microbes 
that cause yellow fever, typhoid fever, malaria, dysen- 
tery and camp diarrhea. 

It is a privilege to die a glorious death on the battle- 
field; no such halo of glory surrounds the death-bed 
in the fever hospital. It is here that the greatest deeds 
of heroism are witnessed. It is here where the true 
manly courage of our Esculapian hero is put to the 
severest tests. Let me ask you a plain, simple ques- 
tion to test the correctness of the assertions I have 
made, a question the significance of which, I fear, is 
not fully understood: If left to choose for yourself, 
would you not be more willing to engage in a battle 
than to live and work in a camp filled with typhoid or 
yellow fever patients? It would take me or any other 
disciple of Esculapius not long to decide in favor of 
the battlefield. 

During the war just ended, the disciples of Escula- 
pius have taken an important and noble part. Cow- 
ardice is unknown in our medical department. Our sur- 
geons have done their duty promptly and well. Escu- 
lapius has watched their conduct and their acts. On 
more than one occasion he shook his massive hoary 
head in disapproval, not because of what they did, 
but of what they could not do. 

Esculapius has drawn his own conclusions from the 
lessons of the war, and now suggests to you and to- 
the people of the United States and their representa- 
tives in Congress the absolute necessity of a complete 
reorganization of the Medical Department. He insists 
that the rank of our Surgeon-General should be that 
of a Major-General, that he should be clothed with 
more executive power, and that he should have his 
own commissary and quartermaster's departments. He 
is satisfied if these important changes in the organi- 
zation of the Medical Department are made, that there 
will be less suffering and deaths from disease should 
we again be called upon to cross swords with another 
nation. 

In conclusion, permit me to ask you to listen to the 



264 

voice of Esculapius in your efforts to effect a thor- 
ough reorganization of the National Guard. The new 
National Guard is destined to become the bulwark of 
the fighting force of our country, which will never 
imitate, much less adopt, the militarism of the totter- 
ing monarchies of the old world. 



NURSING AND NURSES IN WAR. 



One of the grave problems of modern warfare is 
the proper care and nursing of the sick and wounded. 

Our recent experience during the war wdth Spain 
has brought the subject prominently to the attention 
of the military authorities and the people of the 
United States. The war just ended has furnished 
the most instructive and forcible object-lesson, in 
demonstrating the importance and necessity of making 
adequate preparation for the proper care and manage- 
ment of the disabled soldiers in war time. The 
motives which precipitated the war were of the purest, 
noblest kind, arising from the desire to bring freedom 
and liberty to the legitimate owners of our neighbor- 
ing islands, who, under the iron rule of an eflPete, bank- 
rupt monarchy, had been deprived of their liberty, 
happiness and prosperity for centuries. On our part, 
the war spirit was aroused by a sense of duty to our 
neighbors and to advance the cause of humanity on 
our own hemisphere, and not for gain nor conquest. 
It is not strange that our liberty-loving people re- 
sponded so promptly to the call of the Chief Executive 
for volunteers. It required no spefcial foresight to 
predict with certainty that a war with Spain, in Cuba, 
would result in greater loss of life and suffering from 
climate and disease than from the Spanish bullets. 
The result of the war has shown that this expectation 
has been fully realized. 

The short, brilliant campaign on land and sea has 
taught the outside world the strength of our arms, 
and resulted in a victory over a foreign foe, which is 
well calculated to stimulate the pride and patriotism 
for our government and its various departments and 
institutions. The war just ended was characterized 



266 

by the humane treatment of our vanquished enemy, 
and the desire on the part of the government and the 
people to provide the invading army with all the 
necessities and comforts compatible with active war- 
fare. The war cloud came upon us so unexpectedly 
that a certain amount of confusion and un prepared- 
ness in the management of the campaign had to be 
expected. Considering what has been accomplished, 
we have every reason to feel grateful that the prize 
secured was purchased at no greater cost of life and 
suffering. It was our first experience in fighting a 
foreign foe in a foreign land, and the many lessons 
taught and learned will prove of the greatest value 
should we again be called to cross swords with a nation 
beyond the limits of our country. Many of the well- 
founded complaints of the management of the war 
arose, not from any dereliction of duty of the heads 
of the different departments, but were due to a faulty 
organization, and this is particularly true of the med- 
ical department, which has been so severely criticised. 
The executive power of the Surgeon -General is indeed 
an extremely limited one. Everything of importance 
has to pass through the hands and by sanction of the 
Secretary of War. The Secretary of War is a busy 
man in keeping track of what is going on in his de- 
partment outside the Surgeon-General's office. Again, 
the medical department depends entirely on the quar- 
termaster's department in forwarding and distributing 
medical and hospital supplies. No wonder that many 
collisions between these departments occurred during 
the war with Spain. Our experience has taught us in 
a most forcible way that the medical department 
should have charge of everything pertaining to the 
care of the sick and wounded, in order to accomplish 
that for which it is intended. The Surgeon- General 
should be given higher rank and be clothed with more 
executive power, to enable him to discharge his duties 
with credit to himself and greater benefit to those 
who are now only nominally under his charge. The 
Secretary of War is not supposed to possess much 



267 

knowledge of sanitation, medicine and surgery, or 
other wants of the sick and wounded, and yet the 
Surgeon-General is powerless in the execution of his 
orders without his co-operation. If the forwarding 
and distribution of the medical and hospital supplies 
were directly under the control and management of 
the medical department we would have heard less of 
criticism regarding the scarcity of medicines and 
hospital supplies. To make a department strong and 
efficient it must be independent, and invested with 
the necessary power it is expected to wield, and charged 
with a corresponding weight of responsibility. 

The proper care of the sick and wounded in war is 
a subject as old as warfare itself. It is a subject that 
has attracted the liveliest interest of the most famous 
and successful commanders, and that has taxed 
severely the ingenuity and mental resources of the 
most famous military physicians. The soldier who 
risks his life in the defense of the honor of his coun- 
try, when disabled from duty by wounds or disease, is 
entitled to the most humane treatment and the best 
of care on the part of those in whose charge he is 
placed. The moment he is disabled from performing 
his duty he comes under the care of the medical de- 
partment, subject to its rules and regulations. The 
transportation and proper care of the sick and wounded 
are under the management of the medical department. 
The immensity of the labor which devolved upon the 
Surgeon-General and his limited staff of assistants 
during the war just ended must become apparent to 
the general public, when we consider the enormous 
number of the sick in an army of 300,000 men dis- 
tributed from Porto Rico to Manila — nearly one- half 
the circumference of the globe. Hundreds of the 
recently enlisted men had to be detailed for hospital 
duty and were placed in charge of the sick. No won- 
der that among so many some proved absolutely use- 
less in performing the trying duties of an army nurse. 
Nursing in the army in times of war is an occupation 
which is always attended by many difficulties, and 



268 

particularly when the seat of war is in a foreign coun- 
try. The unrest incident to the mobilization of troops, 
the moving and erection of hospital tents, the limited 
facilities for cooking and often for working, the occa- 
sional overcrowding of the allotted hospital space, 
the uncertamty of supplies, are some of the incon- 
veniences which the army nurse must expect to 
meet and correct as far as lies in his power to do so. 
Patience, obedience, perseverance and devotion to 
duty are a few of the most essential virtues conducive 
to satisfactory and successful nursing in war. The 
army nurse, from the very beginning of his philan- 
thropic career, places himself beyond the reach of any 
glory and distinction to be gained on the battlefield. 
His duties are more arduous and taxing than those of 
his comrades of the line. Being constantly in contact 
with infectious diseases he exposes himself to more 
danger than on the battlefield. It requires more 
courage to serve in a yellow fever or typhoid fever 
hospital than to face the enemy on the battlefield. 
The army nurse, with his inadequate pay and no rank, 
has little else to expect but a full measure of ingrati- 
tude. His greatest devotion and best efforts are never 
fully realized and appreciated. If he is competent 
and devoted to his work, his greatest satisfaction must 
consist in the consciousness of duty well performed. 
He is a Samaritan in every sense of the word, whose 
sole object is to serve his disabled combatant comrades. 
Few men are born with intrinsic qualities which con- 
stitute an eflicient successful nurse. A true nurse is 
born, not made. Most male nurses lack the gentle- 
ness of manner and touch which exercise such a sooth- 
ing influence over the fretful, nervous, impatient 
patient. The male army nurse should know something 
about cooking to enable him to prepare some special 
palatable dishes for the sick — an accomplishment 
which but few can claim. To utilize the ordinary 
army rations for this purpose requires tact and skill. 
It is wonderful what can be made out of bacon, beans, 
canned meat, hard tack, salt, spices and water in the 



269 

hands of one skilled in the preparation of special diet. 
It is in this department of nursing that women excel 
men beyond comparison. 

It must be conceded on all sides that the nursing 
in the field during the last war, as well as during any 
of the preceding wars, done almost exclusively by 
male nurses, leaves much to be desired. Many of the 
men enlisted for this special purpose, others detailed 
from the line for the hospital corps, lacked entirely 
the necessary qualifications by nature and training 
for such an important and responsible position. The 
haste with which the war was planned and finished 
precluded the possibility of making a careful selection. 
The tact to make patients comfortable under the most 
adverse circumstances is rarely found in men. To 
anticipate the wishes and carry out the directions of 
the attending physicians, requires more knowledge 
and training than belonged to the average hospital- 
corps men. The hospital-corps men of the volunteer 
forces, mostly new men in the service, did the best 
they could under the circumstances, but their work 
showed a decided lack of discipline and special train- 
ing at a time when their services were most needed. 
With additional experience many of them would come 
up in a comparatively short time to the standard of 
requirements. An earnest willingness to learn and 
improve must be accorded to most of them. It takes 
months of hard work to make a soldier; it takes a 
much longer time to make a good nurse. The mem- 
bers of the hospital corps of the regular army are 
selected with great care, and are required to undergo 
a thorough and systematic course of instruction, hence 
they had an advantage over their comrades of the vol- 
unteer forces, and acquitted themselves more satis- 
factorily in the discharge of their duties. But every 
medical officer is conscious of the fact that even 
many displayed shortcomings which were too con- 
spicuous to be easily overlooked. The average male 
nurse, in private, as well as in military life, works for 
money, and not for the dignity and good standing 



270 

of his profession, or the welfare of his fellowmen. 
The sunny side of the hospital -corps service was to 
be found in the transportation of the sick and wounded. 
No fighting army in the world ever enjoyed better 
ambulance facilities. No army is supplied more lib- 
erally and with better litters and ambulances than were 
in use during the recent war by our troops at home and 
abroad, and no better or more efficient men could be 
found anywhere than those who were placed in charge 
of the transfer of our sick and wounded. The manner 
in which our sick were conveyed from ambulance to 
hospital and from hospital to ambulance, commanded 
the attention and elicited the highest praise from our 
foreign visitors. After my return from Porto Rico, 
on my way from New York to Montauk, I was joined 
by Lieutenant Commander Tomatsuri of the Japanese 
naval medical service and two staff surgeons of the 
German army, who, upon arrival at the camp, watched 
with the greatest interest this part of the work of the 
hospital corps. One of the German surgeons freely 
admitted that our hospital corps men were far more 
efficient in this part of their work than those of the 
German army, and, what commended their work to 
him the most was the gentleness with which the 
patients were handled. He was astonished that a 
hundred or more patients could be transferred with- 
out hearing a rough or angry word, which he assured 
me was rather the exception than the rule in the Ger- 
man army. Hospital construction as witnessed by 
these distinguished foreign observers of our war, 
during th^ early history of Camp Wikoff , was another 
source of surprise and admiration to them. It was 
difficult for them to comprehend that in less than 
three weeks excellent hospital accommodations were 
furnished for nearly two thousand patients. I doubt 
if any of the old countries, always in a state of armed 
neutrality, could repeat what was accomplished by 
our medical department in this direction. Our for- 
eign observers will never forget the impressions re- 
ceived in Camp Wikoff, with special reference to the 



271 

transportation, care and treatment of the sick of our 
returning army from Cuba. Such object-lessons are 
best calculated to impress foreigners with the magni- 
tude and resources of our country and the patriotism 
of our people. 

A new phase in nursing was initiated during the 
last war by the use of hospital ships. The medical 
department of the Army and Navy recognized at the 
proper time the necessity of employing ships adapted 
for the transportation of disabled soldiers from the 
seat of war back to their own country, where they 
could receive better care and nursing and escape a 
prolonged stay in a malarial, semi- tropic country. The 
hospital ships Relief, Solace and Missouri were the 
means of saving hundreds of lives which, without 
such means of transportation, would have perished in 
Cuba and Porto Rico. The horrors enacted on some 
of the transports are more than balanced by the com- 
forts, and even luxuries the sick and wounded enjoyed 
on these floating hospitals on their homeward jour- 
ney. Nothing has done more in saving life and allevi- 
ating suffering than these messengers of mercy on 
their hasty errands to and from the seat of war. It 
was on these vessels that the nation's patients were 
in the care of competent female nurses. Ask any of 
the sick soldiers who returned on any of these ships, 
and you will find him ready to praise and bless the 
female nurse under whose care he was placed on his 
return from the seat of war. He will always remem- 
ber with gratitude her gentleness and devotion to 
the sick under her care. During the four trips I 
made on the hospital ship Relief, to and from Cuba 
and Porto Rico, I had ample opportunity to compare 
the work of the male and female nurses, and I have 
no hesitation in speaking in decided terms in favor 
of the latter. Nursing is woman's special sphere. 
It is her natural calling. She is born a nurse. She 
is endowed with all the qualifications, mentally and 
physically, to take care of the sick. Her sweet smile 
and gentle touch are often of more benefit to the 



272 

patient than the medicine she administers. The 
dainty dishes she is capable of preparing, as a rule, 
accomplish more in the successful treatment of dis- 
ease than drugs. Her sense of duty and devotion 
to those placed under her care are seldom equaled 
by men. The sick soldier, far away from home, rela- 
tives and friends, realizes keenly the superiority of 
female over male nurses, and especially so, if his 
illness is tinged, as is often the case, with homesick- 
ness. It is under such circumstances that the profes- 
sional female nurse is greeted in camp, on board ship 
and in the hospital as an angel of mercy, and every 
look and move she makes are of the keenest interest 
to the expectant sick. For the time being she takes 
the place of the deserted wife, the loving mother or 
the dear sister at the bedside. She watches the 
progress of the disease by day and by night, and 
her heart rises and gladdens with the approach of 
symptoms denoting improvement; deep sorrow and 
tender sympathy take possession of her when, in spite 
of all her exertions, the shadows of death advance. 
Woman is the natural nurse, and nowhere does she 
appear grander or nobler than when she is minister- 
ing to the sick and dying of an army in active war- 
fare. The American woman, above those of any other 
nation, is peculiarly well fitted for such a post of 
duty. She is enthusiastic, energetic, tireless, devoted, 
and, more than all this, intensely patriotic. Our sick 
and convalescent soldiers owe a lasting debt of grati- 
tude to the small army of female nurses who left their 
homes with no expectations of pecuniary gain and 
served their country in camp and field, in fever- 
stricken districts, and in common with them, sufiPered 
the privations incident to an active campaign without 
a word of complaint. 

The demand for trained nurses during the war with 
Spain came suddenly and rather unexpectedly, owing 
to the prevalence of typhoid fever in the National 
camps and later by the return of the sick and wounded 
from Cuba and Porto Kico. Prom the very beginning 



273 

of the war the Surgeon- General's office was over- 
flooded by applications for service in the hospitals 
from all parts of the country. The material to select 
from was enormous, but the task of making a careful 
selection proved to be a difficult one. The Surgeon- 
General was overburdened with the various details of 
his important office and soon found it impossible to 
attend to this part of his duties in person or through 
his assistants. In his desire to supply the sick with 
competent nurses he assigned this duty to Dr. Anita 
McGee of Washington, who was commissioned act- 
ting assistant-surgeon, probably the first time this 
honor was conferred upon a woman in this country. 
The services of Dr. McGee proved of the greatest value 
in selecting from the thousands of applicants a suffi- 
cient number of trained, competent female nurses for 
duty in the hospitals at different points. The Amer- 
ican Red Cross Society did excellent work, not only in 
furnishing supplies of all kinds where and when they 
were most needed, but also in supplying nurses when 
emergencies arose. Miss Clara Barton, the Florence 
Nightingale of this country, president of the society, 
has performed her onerous duties during the entire 
war with a devotion and earnestness that merit 
recognition at home and abroad. She has been tire- 
less in her efforts to bring comfort to the soldiers at 
times when her service were most urgently in demand. 
The State of Texas and the little steamer Red Cross, 
under her command, made their appearance at Siboney 
at a time when outside help was most required. Ice, 
medicines, dressing and hospital supplies were freely 
distributed among the sick and wounded. Miss Bar- 
ton and Mrs. Porter, wife of the secretary of the Pres- 
ident, went to the front, a distance of eight miles, over 
one of the roughest roads imaginable, in an army 
wagon, and extended the work of the Red Cross to the 
very trenches before Santiago. A female nurse and 
a number of male helpers ministered to the sick in 
the Division Hospital in charge of Major Wood. I 
found representatives of the Red Cross in El Caney, 



274 

in the vestry of the old village church, dealing out 
hardtack and flour to the hungry crowds of refugees. 
After the surrender of Santiago the State of Texas 
was the first vessel to enter its harbor on its errand of 
mercy in bringing food for the hungry Cubans, and 
medicines and delicacies for the sick of the victorious 
and vanquished armies. The Ked Cross Society 
established supply depots in all of the large camps, 
and the good work done everywhere will live in the 
memories of all who were engaged in the conflict. I 
was told by a representative of this society that in 
Montauk alone for a number of weeks, supplies to the 
amount of $2000 were distributed daily. The Ked 
Cross female nurses at Siboney did heroic work when 
the sick' and wounded of our army were in the great- 
est distress. Several of these nurses were among the 
first of the yellow fever victims, and had to be taken 
to the first hospital for treatment. The sick and 
wounded Spanish prisoners at Siboney were almost 
exclusively cared for by the Red Cross. 

Miss Barton has the confidence of the American 
people, and she has sustained it through the present 
war by the thoughtful and timely distribution of the 
innumerable and liberal donations to the society she 
so well represents. After peace was declared. Miss 
Clara Barton immediately sailed for Havana to bring 
much-needed aid to the starving reconcentrados of the 
long-besieged city, while her numerous helpers con- 
tinued their faithful work in the home camps. The 
work of the Red Cross received the moral and sub- 
stantial support of the charitably disposed citizens 
throughout the United States, and liberal donations 
from abroad. Recent experience has again demon- 
strated that this society is the most important auxil- 
iary in war as well as other National disasters in bring- 
ing prompt relief to the sufferers. It seems to me 
that the Red Cross Society is the proper organization 
from which to recruit the nursing force should we be 
confronted by another war. This society should be 
made stronger and extend its influence to every part 



275 

of the country. Under the supervision of its repre- 
sentatives, educated, trained nurses should receive ad- 
ditional training preparing them for military service 
and other emergency work. A list of names of nurses 
who had satisfied the proper authorities of their spe- 
cial proficiency for this kind of work should be kept, 
and the selection made from it, should a request be 
made by the medical department for service in the 
army. Provision for competent male nurses for army 
duty should be made by a more thorough training of 
the hospital corps of the National Guard of the States, 
a much neglected subject west of the Alleghany 
mountains. In addition to this, it would be advisa- 
ble to establish training schools for young men in the 
principal cities of the United States, on the same plan 
and for the same purpose as the Samaritan organiza- 
tions in Germany. The training of such men should 
be of the most practical nature, including the trans- 
portation of the sick and wounded, first-aid dressing, 
the art of nursing and cooking, with special reference 
to diet for the sick. An education of this kind would 
be of the greatest value and profit to the pupils as 
well as the respective communities, and would be the 
means of furnishing desirable material for the hosp'i- 
tal corps in case of war and efficient aid in case of ac- 
cidents and National catastrophies necessitating a sud- 
den call for competent nurses. It appears to me that 
such a school of instruction for Samaritans could be 
made attractive and interesting to the pupils, and 
would become a reliable source from which to make 
selections for army nurses and the hospital corps. 

The Sisters of Charity stood in the front rank of 
volunteer nurses in the Spanish war as well as in 
nearly all of the great wars during the last two hun- 
dred years. It is the oldest and best working order 
in the Catholic church. President McKinley became 
familiar with their efficient and faithful services dur- 
ing the Civil War and gladly accepted the offer of the 
Order to furnish nurses, made soon after the war broke 
out. All of the principal hospitals in charge of the 



276 

Sisters of Charity sent representatives to the front. 
They were on duty in nearly all of the National camps 
in Cuba and Porto Rico. The first six sisters were 
sent to the Naval Hospital, Portsmouth, Va., July 16. 
The whole number of sisters on duty September 24 
was 232. The annex and the surgical wards and oper- 
ating tent at Montauk were exclusively in charge of 
100 members of the order. Their work in that great 
camp was a source of gratification to and admiration 
by the medical officers and all of the visitors and 
relatives of the sick. Several of these brave sisters 
have gone to their final reward in the service of their 
country, others are lying dangerously ill in the differ- 
ent hospitals. Too much can not be said in praise of 
thig noble order, as it has always made itself felt in a 
modest but most efficient way in all of the great wars, 
without regard to nationality or creed of the contend- 
ing armies. 

Among the distinguished lay nurses special men- 
tion must be made of Miss Chanler of New York. I 
met Miss Chanler in Ponce, Porto Rico, where she 
did most excellent service in the military hospitals. 
Her numerous patients will always remember with 
deepest gratitude her arduous, unselfish work. The 
Misses Wheeler, daughters of Major-General Wheeler, 
accompanied their heroic father to Cuba, nursed him 
when he was ill and labored earnestly among the sick 
of his command. They continued their labor of love 
at Camp Wikoff, where many a sick soldier owed his 
restoration to health to their unremitting, tender care. 
Diet kitchens were established at Camp Wikoff under 
the supervision of Mrs. M. H. Willard of New York, 
which proved of the greatest benefit for the sick and 
<3onvalescent soldiers. I take the liberty to quote 
from a letter recently received from Mrs. Willard, 
dealing with this subject: "For six weeks I was at 
Montauk, representing the Red Cross Society Main- 
tenance of Trained Nurses, which, together with the 
Massachusetts Volunteer Aid Association, established 
diet kitchens in connectix^n with the Greneral and 



277 

Division Hospitals. On my arrival at Camp Wikoff 
I found the kitchen department in a very serious con- 
dition. The officers, doctors, nurses, orderlies and 
employees, as well as the patients, were procuring 
their food from a small wooden building, presided 
over by an army cook, and everything in and around 
the mess hall was in a dirty condition. Rice and oat- 
meal were the principal diet for the sick, and this was 
so often burned and badly cooked that the patients 
were unable to relish or retain it. The first diet 
kitchen was established August 27, and those at the 
three Division Hospitals soon followed, and this, with 
one at the Detention Hospital, made a system of five 
kitchens, covering a radius of three miles, W' ith a force 
of fifteen cooks, several dieticians, ten volunteers and 
twelve detailed men. These kitchens supplied care- 
fully and scientifically prepared food for the sick and 
convalescent, and the physicians and nurses were able 
to procure for their patients, not only liquid diets, but 
light and special diets as well. One of our prominent 
physicians remarked that his patients were better fed 
at Camp Wikoff than in any hospital in New York 
City with which he had been connected. The Gov- 
ernment soon realized the value of the work, and two 
weeks after the opening of the kitchens they were 
turned over to the officials, and from that time, with 
no cost to private enterprise, the sick soldiers of all 
the hospitals were served, not only with home-made 
broths of beef, mutton and chicken, but also with 
oysters, broiled chicken, tenderloin steaks, chops, jel- 
lies, custards, etc." 

This new enterprise in caring for sick soldiers de- 
serves to be brought to the attention of the general 
public and should receive the strongest encouragement 
in the event of another war. 

The different relief societies. National, State and 
local, did noble work in aiding the Government in 
properly caring for the sick and wounded. The names 
of Miss Helen Gould, Mrs. Ellen Hardin Walworth, 
and scores of other noble-minded, patriotic women 



278 

will always be prominently mentioned in the history 
of the short, decisive war so gloriously ended. The 
charity that has been practiced so bountifully and so 
generally, must satisfy our victorious army that the 
patriotism they carried into the field has been culti- 
vated at home in words and action to a degree and 
extent unparalleled in the history of the world. War 
in a just cause begets patriotism, and nothing can 
demonstrate this more clearly and forcibly than our 
experience in the field and at home during the last 
eventful six months. 



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